Hi All

Well, the landscape and environment have certainly turned on some challenges for those on the land over the last couple of months. And because of that we went quiet for a while to let you deal with the issues that have crossed your paths. We sincerely hope you are in the recovery phase. The double edge sword of the crazy weather cycle is that whilst the water drains from up north we have had to deal with fires down south (including a precautionary evacuation). What a crazy landscape!

But life goes on. The resilience of the Australian people never ceases to astound me. We are truly at our best when circumstances are at the worst.

Our next round of trips up north starts soon, so we will catch up with many of you as we do annually and we are very much looking forward to that. We will be covering quite a few kilometres both by air and by road. Can’t wait!

See you soon.

All the best.

PS. As ever, if there is any stations near you who you think we might be able to help out with First Aid training, please let them know about us, let us know about them.

The post What a crazy landscape! first appeared on Rural & Remote First Aid.

When it comes to getting the right response to any incident the key is clear communication. Unfortunately, the more serious the incident the more scrambled the communication usually becomes as a result of adrenaline and panic.

But this is exactly when we need to have a good system in place to make sure that our response to an incident on station and then engaging emergency services is clear, concise and accurate.

So what are the elements of good communication in an emergency setting? Keeping in mind that communication is a two way process. If we are blabbering over the UHF and there is no one at the other end we are just making noise for no reason. Similarly, if the message doesn’t make any sense we are also just making noise.

So let’s look at the elements that make good communication from where the incident is to the Homestead, who will most likely end up making the emergency call.

Firstly, let’s think about how it should look from the field of the incident.

Start by slowing down and taking in what you’ve got in front of you. The Primary Survey (DRS ABCD) always comes first! This will deal with any life threats immediately.

Of course, the S stands for Send for Help. We will talk about the broader process in another post but today I just want to address communications. So we’ve dealt with any potential life threat and now we’ve picked up the radio to call back to the Homestead or, if serious enough, and we have the capability, we are calling emergency services direct. He is what they need to know.

Location. And this needs to be a pretty good lock in to your position. There is no point having the best information about your patient if no one knows where you are. So if you radio is about to go flat and you have one sentence to get out, tell them where you are! Roads, track junctions, identifiable features are all ideal. I highly recommend downloading the Emergency Plus app to your phone because that will give you latitude and longitude of your location regardless of whether you’ve got phone network or not. (Click here to download the free app) It uses your phones most basic GPS function and will give a pretty good indication of where you are. So failing any other description of where you are just read out the numbers on the screen.

Number of patients. This is really important because it allows the emergency services to activate the right amount of assets to deal with what’s in front of them.

A short history of what happened, ie. the mechanism of injury/incident/illness. This often paints the picture as to how injured or unwell the patient is now and what injuries to look for but also how sick this person could become down the track. It’s another vital piece of information to make sure the emergency response is accurate. If the emergency services are busy with multiple cases the incident will need to be triaged. The better story you can tell about what is going on the better they are able to accurately triage your case.

A quick snapshot of the injury/illness and a set of Vital Signs. Along with the history of the incident the current injuries and the vital signs tell emergency services how sick this person is right now and is another vital piece of information to help them appropriately respond and/or triage your incident.

Then stand by and wait for instructions.

If you’re at the Homestead receiving a call about an incident, the information above is what you want to extract from the caller prior to your activating your response and/or the emergency services. Grab a pen and paper and jot those details down in readiness to launch your own response but also tell the emergency services, if needed. Other information that becomes important is the approximate age and gender of the patient. Those that are younger or older are generally more frail and less resilient to illness and injury so it’s important information to pass on.

I hope this helps.

As ever, if you have any questions about anything please feel free to call 0491 057 339 email info@ruralandremotefirstaid.com.au

The post “Hello homestead. Come quickly! Jacko’s been hurt.” first appeared on Rural & Remote First Aid.

Given some questions we have had about the use of Superglue recently, I thought it topical to address this. This Blog post from https://www.realfirstaid.co.uk addresses the topic well. I have left it original so it speaks of costs in £ and some brands mentioned may not be available in Australia. Please see the article as a good reference point and information only. 

Super Glue for Wound Closure

We often get asked, especially on our Remote First Aid courses, if you can use Super Glue to close cuts? Yes it is perfectly possible to close wounds with glue but there is the legitimate clinical method and the ‘have-a-go-Harry’ approach with whatever Superglue comes to hand.  And there are subtle differences.

When treating our own injuries we take responsibility for our own actions.  When we are treating other people we have a Duty of Care to treat appropriately and cause no further harm or face the serious consequences of litigation. For this reason we would not suggest that glue is used to treat casualties where you are in a position of responsibility be it your role within your workplace or providing opportunistic care for a casualty to have come across.

You may still be inclined to use glue to treat yourself or maybe your trusted climbing partner, in which case, read on:

All Super Glues are not the same.

“Super Glue” or Cyanoacrylate (CA) is an acrylic resin which rapidly polymerises in the presence of water. The principle component of commercial CAs (SuperGlue, Krazy Glue, Loctite) is either methy-2-cyanoacrylate or ethyl-2-cyanoacrylate, the original forms of CA developed in 1942 by Kodak Laboratories. (The discovery was made whilst investigating potential, high clarity, acrylics for the use in gun sights. Whilst not suitable for this application CA was quickly identified as a fast acting, low shear strength adhesive.)

During the Vietnam war it was used in field surgery with good effect, however, despite the promising results it was not approved by the Unites States Food and Drug Administration due to the unknown toxicity and two significant side effects during the polymerization process:

1. The curing process creates an exothermic reaction (heat) which can cause further tissue damage.
2. The process releases cyanoacetate and formaldehyde – both irritants to the eyes, nose, throat and lungs.

Medical Glue

To overcome these harmful issues, new CAs were developed with the express purpose of use in surgery. 2-octyl cyanoacrylate (Derma+flex® QS™, SurgiSeal, FloraSeal and Dermabond) causes less skin irritation and increased flexibility and strength compared to traditional ‘Super Glue’. In 1998 the US FDA approved 2-octyl cyanoacrylate for the closure of wounds and surgical incision and in 2001 was approved as “barrier against common bacterial microbes including certain staphylococci, pseudomonads, and Escherichia coli”.

n-butyl cyanoacrylate wound adhesives are available under the trade names: LiquiBand®, Histoacryl, Indermil, GluStitch, GluShield, and Periacryl (dental adhesive)

Octyl ester, while providing a weaker bond, are more flexible. Butyl esters provide stronger bond, but are rigid.

A cheaper alternative…Veterinary Glues

If you are looking for something for your personal first aid kit and don’t fancy spending £120 on 6 x 5ml vials of Derma Bond, veterinary glues are commercially available as a happy compromise; not licensed for use on humans but essentially the same stuff in a different wrapper.

2-octyl cyanoacrylate Surgi-Lock and Nexaband
n-butyl cyanoacrylate VetGlu, Vetbond and LiquiVet

Contraindications (Terminology: Contraindications means cases when you cannot use it)

Wound adhesives are generally only used on minor wounds, no more than 5cm and with straight edges. Do not attempt to use glue on the following:

• wounds on the face
• wounds where the skin flexes or over joints
• wounds with uneven or jagged edges
• deep wounds
• wounds that are bleeding
• infected wounds
• animal bites
• puncture wounds
• ulcers
• dirty wounds

This last point is critical in a remote or industrial environment since most wounds encountered will typically be dirty in which case it is almost always preferable to clean the wound and pack it ‘open’ with Vaseline  soaked dressings (Tulle Gras) or saline soaked dressings to prevent the wound drying out.   The wound can then be properly cleaned and closed (if appropriate) in a hospital setting later on.

Conclusion

Using glue to close wounds may have been pioneered 50 years ago and continually perfected clinically ever since as well as an established treatment for climbers, string musicians and garage mechanics around the world…but that doesn’t mean it is a panacea.

Given the number of limitations in its use and the issues of liability we would not advise glue is used to treat others.   If you choose to use it to treat yourself, do so…with care and full understanding.

Direct Pressure will stop the majority of even the most serious bleeding wounds and where Direct pressure is not enough there are other options including tourniquets and haemostatic agents.

The post Is Superglue a real option for wound closure? first appeared on Rural & Remote First Aid.

So you’re out in the paddock doing the usual. You’re moving a mob of cattle and they just seem reluctant in the heat of the day to go where you want them to go. Most of you are on horseback, but some of you are on the motorbikes and a couple on a quad bike. One of the cows breaks away from the pack and your mate on a motorbike takes off after it. You roll your eyes because you’ve been doing is long enough to know that you’ve got time to do it carefully. But unfortunately your workmate that has taken off is new and hasn’t taken into account all of the risks involved.

Sure enough, he hits a rut, bounces slightly sideways and collides headfirst with a tree. It actually looks a little bit comical. But as you go over to check him you realise that 40 km an hour on a bike into a tree is pretty hard hit!

You’re trained in first aid so you do your thing, but he is not overly responsive and you start to panic a little. “I need an ambulance” you think to yourself. “I need it now!” But it is going to take some time…….

A simple, but all too common example of what can go wrong when you’re a long way from home. Add to this that home is a long way from anywhere! It’s a no-brainer that you need a good level of first aid training to be of any use out here. But which course is right for you and your organisation?

Typically the defining feature that determines the need for Remote Area First Aid as opposed to ‘normal’ First Aid is the time to access critical care. The ‘normal’ first aid course, or what we used to call Workplace first aid, is okay for interventions on first aid but is designed to assume that access to medical care is within 30 minutes. But this is a little simplistic. There is a little more to it. We need to bring in the Risk factors associated with the location and the type of work being done. For the vast majority of our customers, a medical response timeline of less than 30 minutes is simply not feasible.

The major differences between normal first aid (HLTAID003 Provide First Aid) and Remote Area First Aid (HLTAID005 Provide First Aid in Remote Situations) are; Firstly and fore-mostly, the ability to monitor the patient for an extended period of time post incident and respond to changes that occur in the patient and/or conditions over time. Secondly, the movement of a patient where it is not feasible, for either time or location, for medical aid to reach the site of the incident. Thirdly, a module on risk planning to make sure the appropriate controls are put into place prior to undertaking any activity that the bases have been covered to prevent incidents and to react appropriately if an incident does occur.

For example, lets say the work place is a gas pipeline maintenance site in an isolated location. The nature of the work is hot and manual but the location of the work is only on the defined worksite (ie not mobile up and down the pipeline) and there is an airstrip nearby. The distance by air for an air ambulance is 30 mins from take off to landing. So, just by time alone we could say that the course requirements are for HLTAID003 Provide First Aid, ‘normal’ First Aid would be okay. But, what is the nature of the the work? Are injuries likely to be high impact? How often is the air ambulance not on the ground at its base? What sort of medical facilities and trained personnel (such as paramedics) are on site permanently? The combination of the answers to these and other questions about operation and medical response will determine the level of training needed. Compare the same worksite but we are assessing the https://www.ruralandremotefirstaid.com.au/wp-content/uploads/2020/09/Survival-First-Aid-Kit-new-1.jpgistration team. Clearly the injury risk profile is quite different. Make sure to factor in any pre-existing medical conditions/complaints that might be amongst your workforce.

Contrast that with the worker on a remote cattle station that work away from a base, operates a motorbike around cattle in undulating terrain. Clearly a time and injury risk elevation.

And when in doubt, default to the higher level of training/care possible. The price difference isn’t that large to take a lessor option unnecessarily! The final reminder is that the recommendation is for CPR to be updated every 12 months and all higher course levels to be undertaken every 3 years.

If you not sure where to head with it all, email us on info@ruralandremotefirstaid.com.au or call 0491 057 339. We’ll be happy to guide you through it.

The post Why you need Remote Area First Aid, not just the basics. first appeared on Rural & Remote First Aid.

But this is exactly when we need to have a good system in place to make sure that our response to an incident on station and then engaging emergency services is clear, concise and accurate.

So what are the elements of good communication in an emergency setting? Keeping in mind that communication is a two way process. If we are blabbering over the UHF and there is no one at the other end we are just making noise for no reason. Similarly, if the message doesn’t make any sense we are also just making noise.

So let’s look at the elements that make good communication from where the incident is to the Homestead, who will most likely end up making the emergency call.

Firstly, let’s think about how it should look from the field of the incident.

Start by slowing down and taking in what you’ve got in front of you. The Primary Survey (DRS ABCD) always comes first! This will deal with any life threats immediately.

Of course, the S stands for Send for Help. We will talk about the broader process in another post but today I just want to address communications. So we’ve dealt with any potential life threat and now we’ve picked up the radio to call back to the Homestead or, if serious enough, and we have the capability, we are calling emergency services direct. He is what they need to know.

Location. And this needs to be a pretty good lock in to your position. There is no point having the best information about your patient if no one knows where you are. So if you radio is about to go flat and you have one sentence to get out, tell them where you are! Roads, track junctions, identifiable features are all ideal. I highly recommend downloading the Emergency Plus app to your phone because that will give you latitude and longitude of your location regardless of whether you’ve got phone network or not. (Click here to download the free app) It uses your phones most basic GPS function and will give a pretty good indication of where you are. So failing any other description of where you are just read out the numbers on the screen.

Number of patients. This is really important because it allows the emergency services to activate the right amount of assets to deal with what’s in front of them.

A short history of what happened, ie. the mechanism of injury/incident/illness. This often paints the picture as to how injured or unwell the patient is now and what injuries to look for but also how sick this person could become down the track. It’s another vital piece of information to make sure the emergency response is accurate. If the emergency services are busy with multiple cases the incident will need to be triaged. The better story you can tell about what is going on the better they are able to accurately triage your case.

A quick snapshot of the injury/illness and a set of Vital Signs. Along with the history of the incident the current injuries and the vital signs tell emergency services how sick this person is right now and is another vital piece of information to help them appropriately respond and/or triage your incident.

Then stand by and wait for instructions.

If you’re at the Homestead receiving a call about an incident, the information above is what you want to extract from the caller prior to your activating your response and/or the emergency services. Grab a pen and paper and jot those details down in readiness to launch your own response but also tell the emergency services, if needed. Other information that becomes important is the approximate age and gender of the patient. Those that are younger or older are generally more frail and less resilient to illness and injury so it’s important information to pass on.

I hope this helps.

As ever, if you have any questions about anything please feel free to call 0491 057 339 email info@ruralandremotefirstaid.com.au

The post “Hello homestead. Come quickly! Jacko’s been hurt.” first appeared on Rural & Remote First Aid.

Well, the landscape and environment have certainly turned on some challenges for those on the land over the last couple of months. And because of that we went quiet for a while to let you deal with the issues that have crossed your paths. We sincerely hope you are in the recovery phase. The double edge sword of the crazy weather cycle is that whilst the water drains from up north we have had to deal with fires down south (including a precautionary evacuation). What a crazy landscape!

But life goes on. The resilience of the Australian people never ceases to astound me. We are truly at our best when circumstances are at the worst.

Our next round of trips up north starts soon, so we will catch up with many of you as we do annually and we are very much looking forward to that. We will be covering quite a few kilometres both by air and by road. Can’t wait!

See you soon.

All the best.

PS. As ever, if there is any stations near you who you think we might be able to help out with First Aid training, please let them know about us, let us know about them.

The post What a crazy landscape! first appeared on Rural & Remote First Aid.

Super Glue for Wound Closure

We often get asked, especially on our Remote First Aid courses, if you can use Super Glue to close cuts? Yes it is perfectly possible to close wounds with glue but there is the legitimate clinical method and the ‘have-a-go-Harry’ approach with whatever Superglue comes to hand.  And there are subtle differences.

When treating our own injuries we take responsibility for our own actions.  When we are treating other people we have a Duty of Care to treat appropriately and cause no further harm or face the serious consequences of litigation. For this reason we would not suggest that glue is used to treat casualties where you are in a position of responsibility be it your role within your workplace or providing opportunistic care for a casualty to have come across.

You may still be inclined to use glue to treat yourself or maybe your trusted climbing partner, in which case, read on:

All Super Glues are not the same.

“Super Glue” or Cyanoacrylate (CA) is an acrylic resin which rapidly polymerises in the presence of water. The principle component of commercial CAs (SuperGlue, Krazy Glue, Loctite) is either methy-2-cyanoacrylate or ethyl-2-cyanoacrylate, the original forms of CA developed in 1942 by Kodak Laboratories. (The discovery was made whilst investigating potential, high clarity, acrylics for the use in gun sights. Whilst not suitable for this application CA was quickly identified as a fast acting, low shear strength adhesive.)

During the Vietnam war it was used in field surgery with good effect, however, despite the promising results it was not approved by the Unites States Food and Drug Administration due to the unknown toxicity and two significant side effects during the polymerization process:

1. The curing process creates an exothermic reaction (heat) which can cause further tissue damage.
2. The process releases cyanoacetate and formaldehyde – both irritants to the eyes, nose, throat and lungs.

Medical Glue

To overcome these harmful issues, new CAs were developed with the express purpose of use in surgery. 2-octyl cyanoacrylate (Derma+flex® QS™, SurgiSeal, FloraSeal and Dermabond) causes less skin irritation and increased flexibility and strength compared to traditional ‘Super Glue’. In 1998 the US FDA approved 2-octyl cyanoacrylate for the closure of wounds and surgical incision and in 2001 was approved as “barrier against common bacterial microbes including certain staphylococci, pseudomonads, and Escherichia coli”.

n-butyl cyanoacrylate wound adhesives are available under the trade names: LiquiBand®, Histoacryl, Indermil, GluStitch, GluShield, and Periacryl (dental adhesive)

Octyl ester, while providing a weaker bond, are more flexible. Butyl esters provide stronger bond, but are rigid.

A cheaper alternative…Veterinary Glues

If you are looking for something for your personal first aid kit and don’t fancy spending £120 on 6 x 5ml vials of Derma Bond, veterinary glues are commercially available as a happy compromise; not licensed for use on humans but essentially the same stuff in a different wrapper.

2-octyl cyanoacrylate Surgi-Lock and Nexaband
n-butyl cyanoacrylate VetGlu, Vetbond and LiquiVet

Contraindications (Terminology: Contraindications means cases when you cannot use it)

Wound adhesives are generally only used on minor wounds, no more than 5cm and with straight edges. Do not attempt to use glue on the following:

• wounds on the face
• wounds where the skin flexes or over joints
• wounds with uneven or jagged edges
• deep wounds
• wounds that are bleeding
• infected wounds
• animal bites
• puncture wounds
• ulcers
• dirty wounds

This last point is critical in a remote or industrial environment since most wounds encountered will typically be dirty in which case it is almost always preferable to clean the wound and pack it ‘open’ with Vaseline  soaked dressings (Tulle Gras) or saline soaked dressings to prevent the wound drying out.   The wound can then be properly cleaned and closed (if appropriate) in a hospital setting later on.

Conclusion

Using glue to close wounds may have been pioneered 50 years ago and continually perfected clinically ever since as well as an established treatment for climbers, string musicians and garage mechanics around the world…but that doesn’t mean it is a panacea.

Given the number of limitations in its use and the issues of liability we would not advise glue is used to treat others.   If you choose to use it to treat yourself, do so…with care and full understanding.

Direct Pressure will stop the majority of even the most serious bleeding wounds and where Direct pressure is not enough there are other options including tourniquets and haemostatic agents.

The post Is Superglue a real option for wound closure? first appeared on Rural & Remote First Aid.

Sure enough, he hits a rut, bounces slightly sideways and collides headfirst with a tree. It actually looks a little bit comical. But as you go over to check him you realise that 40 km an hour on a bike into a tree is pretty hard hit!

You’re trained in first aid so you do your thing, but he is not overly responsive and you start to panic a little. “I need an ambulance” you think to yourself. “I need it now!” But it is going to take some time…….

A simple, but all too common example of what can go wrong when you’re a long way from home. Add to this that home is a long way from anywhere! It’s a no-brainer that you need a good level of first aid training to be of any use out here. But which course is right for you and your organisation?

Typically the defining feature that determines the need for Remote Area First Aid as opposed to ‘normal’ First Aid is the time to access critical care. The ‘normal’ first aid course, or what we used to call Workplace first aid, is okay for interventions on first aid but is designed to assume that access to medical care is within 30 minutes. But this is a little simplistic. There is a little more to it. We need to bring in the Risk factors associated with the location and the type of work being done. For the vast majority of our customers, a medical response timeline of less than 30 minutes is simply not feasible.

The major differences between normal first aid (HLTAID003 Provide First Aid) and Remote Area First Aid (HLTAID005 Provide First Aid in Remote Situations) are; Firstly and fore-mostly, the ability to monitor the patient for an extended period of time post incident and respond to changes that occur in the patient and/or conditions over time. Secondly, the movement of a patient where it is not feasible, for either time or location, for medical aid to reach the site of the incident. Thirdly, a module on risk planning to make sure the appropriate controls are put into place prior to undertaking any activity that the bases have been covered to prevent incidents and to react appropriately if an incident does occur.

For example, lets say the work place is a gas pipeline maintenance site in an isolated location. The nature of the work is hot and manual but the location of the work is only on the defined worksite (ie not mobile up and down the pipeline) and there is an airstrip nearby. The distance by air for an air ambulance is 30 mins from take off to landing. So, just by time alone we could say that the course requirements are for HLTAID003 Provide First Aid, ‘normal’ First Aid would be okay. But, what is the nature of the the work? Are injuries likely to be high impact? How often is the air ambulance not on the ground at its base? What sort of medical facilities and trained personnel (such as paramedics) are on site permanently? The combination of the answers to these and other questions about operation and medical response will determine the level of training needed. Compare the same worksite but we are assessing the https://www.ruralandremotefirstaid.com.au/wp-content/uploads/2020/09/Survival-First-Aid-Kit-new-1.jpgistration team. Clearly the injury risk profile is quite different. Make sure to factor in any pre-existing medical conditions/complaints that might be amongst your workforce.

Contrast that with the worker on a remote cattle station that work away from a base, operates a motorbike around cattle in undulating terrain. Clearly a time and injury risk elevation.

And when in doubt, default to the higher level of training/care possible. The price difference isn’t that large to take a lessor option unnecessarily! The final reminder is that the recommendation is for CPR to be updated every 12 months and all higher course levels to be undertaken every 3 years.

If you not sure where to head with it all, email us on info@ruralandremotefirstaid.com.au or call 0491 057 339. We’ll be happy to guide you through it.

The post Why you need Remote Area First Aid, not just the basics. first appeared on Rural & Remote First Aid.