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Post Options Post Options   Quote jeffers Quote  Post ReplyReply Direct Link To This Post Posted: 17 Jan 12 at 7:26am
The problem is that unless you have a trained paramedic in each 'safety' boat you are never going to be able to cover all possibilities.
 
Spine and neck injuries are a possibilites but give that (most) dinghy crashes are low speed and most people crewing safety boats at sailing clubs are volunteers you have to give them an overview of the most likely situations which are drowning and hypothermia.
 
At the end of the day you and only do what you can do at any given incident. Regretably sometimes this may not be enough (this from a former first aider who had someone die on them from a heart attack). The main priority is to get the casualty out of the water and administer first aid and get them ashore as quickly and safely as possible. At that point the professionals can take over.
 
No doubt there can be lessons learnt from this incident not least of which is observation is key when sailing on a crowded race course and being aware of potential incidents (and giving additonal requirements to hail may help).
 
At large events such as this one then it may be practical to have at leat 1 safety boat crewed with a paramedic, at grass roots level this is just not possible.
Paul
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Posted: 17 Jan 12 at 2:11pm
Originally posted by jeffers

The problem is that unless you have a trained paramedic in each 'safety' boat you are never going to be able to cover all possibilities.

that's odd given pool lifeguards with the NPLQ and  St John Ambulance 'Advanced First Aiders ( under the 2011/12  skill sets)' are taught  casualty handling  for the patient with a suspected  spinal injury  based on mechanism of injury .

ditto for none Paramedic ambulance staff including  the voluntary sector crews  as well as technicans and assistant grades in the NHS, Some of whom will be using the JRCALC selective immobilisation guidelines as well.

have we got any RNLI personnel or Mountain rescue types who could let us know what is taught at a basic level and for designated casualty care pers ?

Spine and neck injuries are a possibilites but give that (most) dinghy crashes are low speed and most people crewing safety boats at sailing clubs are volunteers you have to give them an overview of the most likely situations which are drowning and hypothermia.

Volunteer  does not  have to mean incompetent or undertrained , would you be quite so forgiving of volunteer Race Officer who couldn't  do a general recall ? 

 
At the end of the day you and only do what you can do at any given incident. Regretably sometimes this may not be enough (this from a former first aider who had someone die on them from a heart attack). The main priority is to get the casualty out of the water and administer first aid and get them ashore as quickly and safely as possible. At that point the professionals can take over.
 
No doubt there can be lessons learnt from this incident not least of which is observation is key when sailing on a crowded race course and being aware of potential incidents (and giving additonal requirements to hail may help).
 
At large events such as this one then it may be practical to have at leat 1 safety boat crewed with a paramedic, at grass roots level this is just not possible.

You don't need a Paramedic to be able to provide adequate casualty care ...

also  a safety boat is a poor platform to perform  actual 'Paramedic' ( or other Healthcare professional only ) interventions  vs life saving first aid intereventions and  safely packaging someone for transfer to shore/ a larger  boat / rescue helicopter where  you can provide advanced life support care.




Edited by zippyRN - 17 Jan 12 at 2:16pm
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Post Options Post Options   Quote ASok Quote  Post ReplyReply Direct Link To This Post Posted: 17 Jan 12 at 2:16pm
Originally posted by zippyRN

For those asking aobut injury prevalence etc  - a  very quick and dirty literature review throws up a variety of discussion in professional literature as well as general news items and specific information from sailing clubs 








part of the problem is drilling down through all the over use vs acute trauma and the fact that 'sailing' as a whole  can  cover a variety of disciplines - including  windsurfing and kiteboarding at times as well as dinghy / keelboat/ yacht
 
I'm not sure why you have posted any of these references. I know this is a 'quick and dirty' review, but I don't believe they show any credible evidence of risk to spines in this sport. The reports reference that head injuries account for between 22-35% depending on the reference used and those references do not take into account degrees of injury. The statistics could include everything from a little bump to a great whack, mid-gybe.
 
I have faith that the RYA has people well versed in researching this topic. If it was a significant issue then the RYA as a governing body would be reviewing training and issuing new guidance. As people have noted above, they haven't.
 
The main issue here is ensuring that clubs put two in the safety boats. Thats a basic step and hard enough to achieve for some, without adding additional responsibility to the mix.
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Post Options Post Options   Quote jeffers Quote  Post ReplyReply Direct Link To This Post Posted: 17 Jan 12 at 2:43pm
Originally posted by zippyRN

that's odd given pool lifeguards with the NPLQ and  St John Ambulance 'Advanced First Aiders ( under the 2011/12  skill sets)' are taught  casualty handling  for the patient with a suspected  spinal injury  based on mechanism of injury .
 
The difference is Pool Lifeguards are paid and employed specifically to be responsbile for safety. MOST sailing clubs are run by VOLUNTEEERS who give up their free time.
 
Also MOST sailing clubs would fold should there suddenly become a requirement for safety boat crews to hold an advanced first aid certificate (which I seem to recall is a 5 day+ course) partly on cost and partly because I don;t know many people who would want to do that.
 
It is all about getting the casualty to safety so the professionals can do their job, this incluides getting them out of the water. I would not like to see a spinal board being used in rough conditions. Even at my local club (which is inland) the safety boats rock about quite a lot.
 
Given the option of pulling someone out of that water and saving their life from certain death over leaving them in the water to die because they 'might' have a spinal injury which 'might' be aggravated by my actions I know which option I would take every time.
 
Perhaps if you have serious concerns you should speak to the RYA, I know they have a lot of advice and a good legal team who will be able to assist if required.
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Posted: 17 Jan 12 at 3:14pm
Originally posted by jeffers

Originally posted by zippyRN

that's odd given pool lifeguards with the NPLQ and  St John Ambulance 'Advanced First Aiders ( under the 2011/12  skill sets)' are taught  casualty handling  for the patient with a suspected  spinal injury  based on mechanism of injury .
 
The difference is Pool Lifeguards are paid and employed specifically to be responsbile for safety. MOST sailing clubs are run by VOLUNTEEERS who give up their free time.


SOME  pool lifeguards are paid staff , i also note you have conveniently skirted the issues of the other  volunteers mentioned in my previous posts 

 
Also MOST sailing clubs would fold should there suddenly become a requirement for safety boat crews to hold an advanced first aid certificate (which I seem to recall is a 5 day+ course) partly on cost and partly because I don;t know many people who would want to do that.

would they ?  the same  arguments against developing standards have been trotted out elsewhere , including the excuses that  because a service is provided by volunteers  it shouldn't have to meet any kinds of standard 

It is all about getting the casualty to safety so the professionals can do their job, this incluides getting them out of the water. I would not like to see a spinal board being used in rough conditions. Even at my local club (which is inland) the safety boats rock about quite a lot.

I'd much rather see someone safely packaged on an extrication board than dragged into the bottom of a safety boat in an uncoordinated fashion 

 
Given the option of pulling someone out of that water and saving their life from certain death over leaving them in the water to die because they 'might' have a spinal injury which 'might' be aggravated by my actions I know which option I would take every time.

ah  the excuse of lay person necessity  rather than of having pride in delivering service 

do not think being a volunteer or an organisation being a not for profit  will prevent  individuals or the organisation being prosecuted. 

Interestingly the landmark case in this respect involves a rescue boat ... operated by St John rather than a sailing club


 
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Post Options Post Options   Quote jeffers Quote  Post ReplyReply Direct Link To This Post Posted: 18 Jan 12 at 7:23am

zippyRN, you and I are clearly not going to agree on this. Our sport is self regulalted and, on the whole, well managed with very few serious incidents.

To expect what you are expecting of people who give up their free time to participate and help run the sport is unreasonable and would sound the death knell for many clubs in the UK.
 
That is my opinion and my final wording on the matter.
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Post Options Post Options   Quote sargesail Quote  Post ReplyReply Direct Link To This Post Posted: 18 Jan 12 at 8:11am
Over zealous application of a specialist area, undestandly due to exposure to the consequence of spinal injuries.

Lifeguards need training.  People break their necks and backs diving into pools every year.  

In thirty years of sailing I have not heard of a single spinal injury, there is no evidence in them in the water related accident stuff, and I have not even seen anything in the reporting of the  incident that sparked this thread to link it.

More pertinent:  I have twice been involved in CPR in a rescue situation.  Once I gave it in the water.  I'm not sure it was needed, and I'm not sure it was effective: it's near impossible in even the most benign conditions.  But the guy coughed up the water and was OK.  In the second case it was a hard stint in the rescue boat.  No way it could have been done in the water.  It's all about the priorities.

In my professional life I deal with risk management.  It's about probability against consequence then mitigation.  No matter what the serious of the consequence if the probability is nil or next to it then there is no need to treat the risk.

But I have seen senior practitioners pick up on threads like this and take actions which diverted resources and actually increased risk to life elsewhere.  So forgive me if I seem a little robust but this touches a nerve, and frankly, in comments like "lay person necissity" offends.


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Post Options Post Options   Quote Buzz Quote  Post ReplyReply Direct Link To This Post Posted: 18 Jan 12 at 10:55am
We sail on the sea and our guidance is that in the event of a serious injury we would call the Coastguard. The Inshore Lifeboat carries a spinal board and the crews are all trained in its use. I have never seen such an injury during sailing but have experienced it with a waterskier being hit by another ski boat and one of the club safety boats being asked to assisst.
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Posted: 18 Jan 12 at 2:52pm
Originally posted by sargesail

Over zealous application of a specialist area, undestandly due to exposure to the consequence of spinal injuries.

Lifeguards need training.  People break their necks and backs diving into pools every year.  

as for it'll never happen we've got a girl anaesthetisted in an Australian ICU after a head injury that required Neurosurgery ...

while she's still anaesthetised  we don't know the full consequences of her injury, every textbook on emergency care will tell you that someone who is knocked out  through head trauma has a presumptive spinal injury until proven otherwise , this cannot be ruled out by imaging alone , although stability of the spine can be determined as such. 

there's also Herb Meyer who sustained a C5/6 injury while sailing  , ok Yacht rather than small boat ... 

also what aobut someone who falls from a dock or pontoon into the water  and sustains a neck injury?  while it's not directly as a result of going sailing ... 


In thirty years of sailing I have not heard of a single spinal injury, there is no evidence in them in the water related accident stuff, and I have not even seen anything in the reporting of the  incident that sparked this thread to link it.

 and what are your casualty care  credentials ?  are you  involved in emergency care  as a none incidental  activity , whether professional or paid ...?

More pertinent:  I have twice been involved in CPR in a rescue situation.  Once I gave it in the water.  I'm not sure it was needed, and I'm not sure it was effective: it's near impossible in even the most benign conditions.

it is deemed as such I believe the RLSS still teach it for pool work but only once to the side  ( obviously in a wave pool with a 'beach' you just tow then  drag the casualty  until they are 'landed' )

  But the guy coughed up the water and was OK.  In the second case it was a hard stint in the rescue boat.  No way it could have been done in the water.  It's all about the priorities.

exactly and unfortunately unless a rescue boat has a clear , flat  deck area where you can lay your patient to perform CPR you will not be able to perform effective CPR  ( see debate in the Michael Jackson case  over whether the CPR being done on the bed by Dr. Murray and Jackson's staff was effective  vs the Ambulance crew moving him to the floor  and then to  their  ambulance trolley  which provides a hard surface )

In my professional life I deal with risk management.  It's about probability against consequence then mitigation.  No matter what the serious of the consequence if the probability is nil or next to it then there is no need to treat the risk.

that is simply not the case especially when a 9 figure  Dollar / Euro  or very large 8 figure GBP payout is at stake -  8 million GBP  seems to be a fairly common payout  for those with high tetraplegia or enduring head injuries requiring 24 hour care post incident  and the legal eagles say it;s only a matter of time before there's a 10 million GBP payout ... how much public liability insurance does the average club carry ? 

But I have seen senior practitioners pick up on threads like this and take actions which diverted resources and actually increased risk to life elsewhere.  So forgive me if I seem a little robust but this touches a nerve, and frankly, in comments like "lay person necissity" offends.

so tell me how does ensuring that rescue boats have a two person crew and that people have an awareness of issues and access to equipment  increase the risk in other ways ? 

kit wise you are talking about an investment of a few hundred pounds and that's assuming you can't negotiate access to existing stocks of equipment or find funding for it ... 

providing this training to not for profit / charity clubs would count as a charitable purpose for the likes of SJA , the RLSS or the Red Cross  of course assuming that  we can't find  faculty from within the sailing community itself - how many health professionals, lifeboat and Coastguard personnel , firefighters  etc  sail or have links with the sailing community ? 

when people start talking about putting 'Paramedics' on rescue boats to deliver casualty care that first aiders and firefighters  do  it's obvious there is an understanding gap. 




Edited by zippyRN - 18 Jan 12 at 3:01pm
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Posted: 18 Jan 12 at 3:04pm
Originally posted by zippyRN

Originally posted by sargesail

Over zealous application of a specialist area, undestandly due to exposure to the consequence of spinal injuries.

Lifeguards need training.  People break their necks and backs diving into pools every year.  

as for it'll never happen we've got a girl anaesthetisted in an Australian ICU after a head injury that required Neurosurgery ...

while she's still anaesthetised  we don't know the full consequences of her injury, every textbook on emergency care will tell you that someone who is knocked out  through head trauma has a presumptive spinal injury until proven otherwise , this cannot be ruled out by imaging alone , although stability of the spine can be determined as such. 

there's also Herb Meyer who sustained a C5/6 injury while sailing  , ok Yacht rather than small boat ... 

also what aobut someone who falls from a dock or pontoon into the water  and sustains a neck injury?  while it's not directly as a result of going sailing ... 


In thirty years of sailing I have not heard of a single spinal injury, there is no evidence in them in the water related accident stuff, and I have not even seen anything in the reporting of the  incident that sparked this thread to link it.

 and what are your casualty care  credentials ?  are you  involved in emergency care  as a none incidental  activity , whether  volunteer or paid ...?

More pertinent:  I have twice been involved in CPR in a rescue situation.  Once I gave it in the water.  I'm not sure it was needed, and I'm not sure it was effective: it's near impossible in even the most benign conditions.

it is deemed as such I believe the RLSS still teach it for pool work but only once to the side  ( obviously in a wave pool with a 'beach' you just tow then  drag the casualty  until they are 'landed' )

  But the guy coughed up the water and was OK.  In the second case it was a hard stint in the rescue boat.  No way it could have been done in the water.  It's all about the priorities.

exactly and unfortunately unless a rescue boat has a clear , flat  deck area where you can lay your patient to perform CPR you will not be able to perform effective CPR  ( see debate in the Michael Jackson case  over whether the CPR being done on the bed by Dr. Murray and Jackson's staff was effective  vs the Ambulance crew moving him to the floor  and then to  their  ambulance trolley  which provides a hard surface )

In my professional life I deal with risk management.  It's about probability against consequence then mitigation.  No matter what the serious of the consequence if the probability is nil or next to it then there is no need to treat the risk.

that is simply not the case especially when a 9 figure  Dollar / Euro  or very large 8 figure GBP payout is at stake -  8 million GBP  seems to be a fairly common payout  for those with high tetraplegia or enduring head injuries requiring 24 hour care post incident  and the legal eagles say it;s only a matter of time before there's a 10 million GBP payout ... how much public liability insurance does the average club carry ? 

But I have seen senior practitioners pick up on threads like this and take actions which diverted resources and actually increased risk to life elsewhere.  So forgive me if I seem a little robust but this touches a nerve, and frankly, in comments like "lay person necissity" offends.

so tell me how does ensuring that rescue boats have a two person crew and that people have an awareness of issues and access to equipment  increase the risk in other ways ? 

kit wise you are talking about an investment of a few hundred pounds and that's assuming you can't negotiate access to existing stocks of equipment or find funding for it ... 

providing this training to not for profit / charity clubs would count as a charitable purpose for the likes of SJA , the RLSS or the Red Cross  of course assuming that  we can't find  faculty from within the sailing community itself - how many health professionals, lifeboat and Coastguard personnel , firefighters  etc  sail or have links with the sailing community ? 

when people start talking about putting 'Paramedics' on rescue boats to deliver casualty care that first aiders and firefighters  do  it's obvious there is an understanding gap. 


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