Herrick Trauma Care Lessons Forgotten??

[theoriginalphantom]

Back in the 1950's when I was a Wolf Cub we were taught how to apply a tourniquet and which were the pressure points, and how often to release the tie. Has all this been ditched from public first aid training? Certainly I had none in the Army beyond being given a field dressing and a couple of ampules of morphine to tape to my dog tags.

Tourniquets went in and out of use for First aid a couple of times since then.
If used badly they can make things worse, which is why I was glad to get rid of the old samway anchor and the singer screwgate tourniquets for the CAT.
Mind you, a single CAT isn't always enough for a limb injury.

 

[alfred_the_great]

Back in the 1950's when I was a Wolf Cub we were taught how to apply a tourniquet and which were the pressure points, and how often to release the tie. Has all this been ditched from public first aid training? Certainly I had none in the Army beyond being given a field dressing and a couple of ampules of morphine to tape to my dog tags.

What public 1st aid training?

 

[dingerr]

That bomb scene will have been total carnage, dead injured and dying everywhere, glass and debris to hamper proceedings and a mixture of public, private security and emergency services all moving in different directions. There will be shear panic unlike anything that 99% of people have or should ever have to experience. At an educated guess the closest the Ambulance will have got is 100m. Paramedics are great people, with great skills, but very few are fit, carrying all that kit, even that short distance and exhaustion sets in. They enter the scene to screams and shouts- where do you start? Triage? How effective is that going to be? They will also have to treat as they go along, some will be simple, walking wounded “you’ll survive, make your way to the entrance”. Others will require substantially more treatment, the clocks ticking all the time and explosions cause hidden wounds. The paramedics simply don‘t have the luxury of time, location or equipment to 100% check absolutely everyone. Maybe, just maybe, if she had been on her own with similar injuries the paramedics could have pulled off their usual miracle.

They did what they did with the threat of secondary and tertiary devices around them.

When I was injured everyone was 100% on their game that day. My No2 and bleep were walking wounded and no one realised that the search team commander was missing. I was the point of focus, a bloody good medic, commanding several other blokes what to do. Experienced people who created order in amongst a chaotic situation. I had 5 tourniquets on me and God only knows how much other shit.

Other factors in my favour - We were at PB Sandford, not far from Bastion, the crew and medics were on the MERT (having just turned it around from a previous task). Fit lads carried me up a hill, I was in the MERT and on the operating table in Bastion within 20minutes. The best trauma hospital in the world with the best trauma specialists. If I’d had a car accident on the A38 a mile from QEHB and suffered just some of the injuries I had then I probably wouldn’t have survived.

That day, 15 Nov 2009 was a collision of small miracles coming together that really gave me the miracle of life.

It’s tragic that this little girl has died, but if the paramedics have done the best the can in the situation they were in and have not done something recklessly negligent, lets just accept that these miracles don’t happen every day and say to these medics ‘well done, you did your best and there is nothing more anyone could do. Thank you’.

 

[Poppycock]

say to these medics ‘well done, you did your best and there is nothing more anyone could do. Thank you’.

100% agree, the point of the thread was never intended to criticise the medics on the day.

WRT 8-year old Saffie-Rose Roussos, the youngest fatality, she was removed from the scene without any treatment (just wrapped in Mr Reid's coat) relatively quickly by Paul Reid, a poster-seller at the concert. She was the first casualty to reach an ambulance outside that had been flagged down, so the circumstance of her treatment were different to those you describe.

The point of the thread is to ask why the ambulance paramedics / nursing staff at the hospital weren't passed on the skills & kit that were learnt & utilised by the RAMC in Bastion role 3. If all that knowledge & experience that saved so many in Helmand has been lost or discarded already, then that's beyond my comprehension.

In case you didn't see it posted before:

 

[stacker1]

There will be shear panic unlike anything that 99% of people have or should ever have to experience.

That line is what some of the heroes on here should remember, not everyone is a battled hardened, war experienced, double hard ninja.

There is a theme on ARRSE that whenever there is an incident, certain people sat on their arse in an armchair in a nice safe warm environment slate people for making mistakes in the middle of a tragedy.

 

[labrat]

The point of the thread is to ask why the ambulance paramedics / nursing staff at the hospital weren't passed on the skills & kit that were learnt & utilised by the RAMC in Bastion role 3. If all that knowledge & experience that saved so many in Helmand has been lost or discarded already, then that's beyond my comprehension.

And it has to be stressed that it’s right for these questions to be raised at the inquest (a process we are going through with my own daughters death at the moment) - that is very much the point of the inquest, to identify lessons that can be learned for the future. It’s not simply ‘second guessing’ the people on the day, it’s looking at prevention of future deaths.

 

[stacker1]

Back in the 1950's when I was a Wolf Cub we were taught how to apply a tourniquet and which were the pressure points, and how often to release the tie. Has all this been ditched from public first aid training? Certainly I had none in the Army beyond being given a field dressing and a couple of ampules of morphine to tape to my dog tags.

Was taught Tourniquets in Army, late 80s, and in 90s.
Marker pen T on casualty's forehead with time applied.

(M for morphine)

Although all soldiers get basic first aid training, there are also team medic course that last between two and four days depending on how it is run. The qual last for two years.
The idea was that soldiers could deal with an injury in the golden hour/platinum 10 minutes until someone with real medical training could take over.
Some units deploying had one in four soldiers with the qual.
Having said that, having the qual gained in a nice warm classroom having done the test on a perfectly healthy patient doesnt mean you will be able to handle an incident after seeing your mate screaming from losing a limb while you are still under attack.
When I was in FOB Inkerman all team medics were told to report outside of the medical tent for a mass casualty event (Early report of up to 20 booties being blown up), most of us were support arms and I could see from everyone's faces that I wasn't the only one trying to remember my short training from months in the past. In the event it was the locals who who got blown up and most were dead so the real medical team could deal with the survivors when they were brought in.
I have no doubt if it had been 20 seriously injured cabbage heads, then at least one of them probably would have died due to a mistake made by the team medics, all of whom were trained soldiers, so I have some sympathy for the poor ******* having to deal with a major terrorist event and not being absolutely perfect.

 

[chimera]

, what do her parents want ?,

1. Money
2. Self Publicity in order to revisit 1 above

 

[stacker1]

1. Money
2. Self Publicity in order to revisit 1 above

Possibly true, but equally they could be grief stricken and want to blame someone, meanwhile they will have ambulance chasers, sections of the media and maybe politicians stirring it up.

 

[theoriginalphantom]

On my penultimate tour I was working with a team who had very little tour experience, and some were not very experienced medics (not their fault and the 'kids' were especially professional unlike the supposedly SNCO nurse), I was the only one with any practical mass casualty experience.
Fortunately we had chance to practice and improve a few of our procedures before we got our first live mass casualty shout on j-chat.
Despite modern communications and training, it was not a mass casualty call. this allowed us to get setup and practice with the adrenaline of thinking it was real. This happened a few times so when it came to the real ones we were fairly well prepared. (complete with my sign stating something along the lines of 'major incident - kindly **** off')
Our biggest one was 34. Mainly women and children.

I spent 45 minutes just moving them from the HLS to the med centre. Just so many helicopters. "They just kept coming"
Everyone local to the HLS was helping - British troops, Americans, LEC's. this is the part that gets me close to being emotional
We called forward all available team medics - one of them was an absolute legend, not because he was a great medic, but because he was clearly unhappy dealing with the injuries - but he wouldn't leave 'his' casualty. We wrote to his CO afterwards praising him but asking that the don't use him as a team medic. he also required some counselling afterwards.

We had the advantage in this situation of receiving casualties where all our kit was, where there a lot of people to help, and some had received treatment before evacuation. We were also in a safe location, compared to the POW.

on the plus side

 

[dingerr]

And it has to be stressed that it’s right for these questions to be raised at the inquest (a process we are going through with my own daughters death at the moment) - that is very much the point of the inquest, to identify lessons that can be learned for the future. It’s not simply ‘second guessing’ the people on the day, it’s looking at prevention of future deaths.

Unfortunately inquests of late also appear to be apportioning blame without a real understanding of the situation at the time.

 

[Fang_Farrier]

That line is what some of the heroes on here should remember, not everyone is a battled hardened, war experienced, double hard ninja.

There is a theme on ARRSE that whenever there is an incident, certain people sat on their arse in an armchair in a nice safe warm environment slate people for making mistakes in the middle of a tragedy.

I don't think I've read any slating on this thread.
There has been an expression of understanding of the great difficulty that those dealing with the incident would have had.
I would have to reread the posts but I don't recall any one saying that those on the ground made mistakes.
A lack of training and equipment perhaps but overall I thought this thread was sympathetic to their plight.

 

[solomon88]

Unfortunately inquests of late also appear to be apportioning blame without a real understanding of the situation at the time.

In some of these cases I do wonder if the Coroners are going a bit too far. I know they can make recommendations but they shouldn't give subjective opinions.

 

[Himmler74]

That line is what some of the heroes on here should remember, not everyone is a battled hardened, war experienced, double hard ninja.

There is a theme on ARRSE that whenever there is an incident, certain people sat on their arse in an armchair in a nice safe warm environment slate people for making mistakes in the middle of a tragedy.

Our hero @NSP is qualified to speak on issues regarding receiving heavy enemy fire, honourable mentions to dodgers @ACAB @Simmerit

 

[stacker1]

I don't think I've read any slating on this thread.
There has been an expression of understanding of the great difficulty that those dealing with the incident would have had.
I would have to reread the posts but I don't recall any one saying that those on the ground made mistakes.
A lack of training and equipment perhaps but overall I thought this thread was sympathetic to their plight.

I think claiming people have forgot the lessons of Helmand that has resulted in the "highest price you could imagine" followed by a clip of a dead child is slating.

 

[ACAB]

Our hero @NSP is qualified to speak on issues regarding receiving heavy enemy fire, honourable mentions to dodgers @ACAB @Simmerit

Ahhh, did your bottom lip tremble whilst posting that kin utter bovine excrement????

I bet it did, and I bet you posted it in this forum coz you believed we would be all sweary and get banned.

You are an utter melt.

This post was sponsored by the SPoTY 2020 @Himmler74

Edit - I'm going to add that to my signature block....

 

[Fang_Farrier]

I think claiming people have forgot the lessons of Helmand that has resulted in the "highest price you could imagine" followed by a clip of a dead child is slating.

I took it to be more about a system failure rather than individuals making mistakes.

The clip was of a news report which did state that experts said her injuries were not survivable.

Medical advances are common and occasionally rapid in war time, their transition to civilian use can take longer.

 

[Simmerit]

Ahhh, did your bottom lip tremble whilst posting that kin utter bovine excrement????

I bet it did, and I bet you posted it in this forum coz you believed we would be all sweary and get banned.

You are an utter melt.

This post was sponsored by the SPoTY 2020 @Himmler74

Edit - I'm going to add that to my signature block....

excellent footer

 

[Egg on Leggs]

From someone who was there, referencing the herrick lessons going into nhs.

"They got it because they helped look after them back in the QE/Selly Oak- plus the doctors were working within trusts. Pro Keith Porter did a lot of work as he was working as head of trauma during the time period so a lot of it was put out to the wider NHS through conferences, teaching, articles ect"

Whether the advanced techniques got as far as ambo/paramedic I cannot comment on.

 

[Effendi]

Was taught Tourniquets in Army, late 80s, and in 90s.
Marker pen T on casualty's forehead with time applied.

(M for morphine)

Early 80's through to the late 80's we had FFD's and triangular bandages/arm sling officially, some blokes took it upon themselves to put together their own kits with stuff borrowed from the med-centre. FFD were applied to wounds, up to 3 were to be used on a major bleeder, I vaguely remember. Ring dressings/bandages were knocked up out of a triangular bandage/arm sling. Chest seals were improvised out of the wrapper of a FFD. No celox back then, the trick was to burn one FFD in a mess tin, drop the sterile ash into the wound and then whang the second FFD over the top. The closest anyone came to a nasopharangyl airway was carrying a bic biro that you do insert after performing a tracheotomy with the stanley knife blade you kept in your cleaning kit. The bungee someone used to hold their webbing tight became a tourniquet if they needed one.

I'm glad that things changed, albeit after I left the regulars.