Tag Archives: British Columbia

ITLS site visit

We’re at T-7 days until our second ITLS course for North Shore Rescue.  This course will also mark our site visit for our sign-off as an ITLS Training Centre.  Ian, Devon, and I are all divying up tasks and figuring out a teaching schedules.

We’ve done this before, there have been years where I’ve taught more than one course per week, but the added pressure of our certification as an ITLS Training Centre is putting a certain stress on us.  North Shore Rescue is always a great group to work with!

Airway Management Training

For the past week, Devon, Ian and I have been in the classroom.  Well, okay, Ian’s been in there for a heck of a lot longer as a member of the design team. Devon and I joined him this week after attending an early pilot of the course.  We’ve been in there working on a new BCAS course offering, AIME 2 for BLS.

There are few topics in EMS education that excite me like airway management.  It is so fundamental to what we do as health care professionals, but beyond the “look, listen, feel” we all learned in our first CPR course, it’s rarely touched on except to give us new pieces of plastic as we ascend the skill and license ladder.  We spend hours working on BC, we sometimes forget the A.

AIME is one of those courses that fundamentally changes how you practice prehospital care.  It twists your viewpoint around and shows you what you could, and must, do better.  It puts a mirror on years of ingrained practice and asks “is that the best you could do for that patient?” over and over. And it’s kind of uncomfortable.  It’s that perfect kind of uncomfortable that makes you perform at your best.

The AIME instructor selection process is brutal.  It is draining, it is soul crushing at times.  You bring all of your EMS and educational skills to the table and you have them picked apart by true experts.  Think you know how to run a skill station? Let’s see what the PhD education expert has to say.  Think you know prehospital airway care? Let’s see what the expert EMS physician thinks about that.  And if you think you know the course content? We’ve got a guy for that too.  It is grueling.  At the end of the day, though, you walk out far more confident in your skills, both as an educator and as a provider.

Wound packing & Hemcon

Direct pressure is the mainstay of hemcon, but it’s one that isn’t necessarily well applied.

One of our local ERP used to accuse paramedics of using “pillow pressure” versus “pinpoint pressure.”

The difference, as the names imply, is one of location.  Pillow pressure is the tendency of responders to take a large dressing, abd pad, etc. and apply it over top of the wound, using something to hold it in place against the skin.  Pinpoint pressure, on the other hand, is to directly visualize the site of the bleeding and put pressure directly on the bleeding vessel.

Bodies don’t just spontaneously bleed.  Blood vessels are damaged or severed due to a mechanism, and bleed from the site of that damage. Putting pressure on the site of the bleeding is the way to stop it.  Putting pressure in the general vicinity of the bleed doesn’t really do much to stop the hemorrhage.

TCCC and TECC advocate the use of hemostatic dressings, but we need an understanding that the dressings (and the hemostatic agent) need to get down to the actual site of the bleeding in order for them to be effective.  Simply filling a hole with gauze isn’t going to do much.  Filling a hole with gauze that applies pressure to the vessel is going to be far more effective than a poorly placed hemostatic agent.

There is a huge amount of information on the internet about TCCC/TECC, some accurate, some not.  There are a million companies lining up to sell you a blowout kit.  There is no point in carrying a pouch stuffed full of things you don’t know how to use, especially if misuse can worsen your patients condition.

Wound packing is a simple skill, easily learned, quickly applied, and incredibly effective.  A skill everyone who may have to control hemorrhage should have.