Extended Care Module

1
Australia Ski Patrol Association

• Extended Care Module
• and the
• Benefits to
• Small Remote Patrols
• Presented by
• Rocky Findlater

2
Australia Ski Patrol Association

• One of ASPAs main roles is as a training
  organization
• There are three main courses made available to
  its Patroller members
• AEC (Advanced Emergency Care Course)
• National on Snow
• ECM (Extended Care Module)

3
Patrols in Australia

• There are three States where skiing is possible
  in Australia
• All three States have Patrols members of ASPA
  (Australian Ski Patrol Association)
• these are
• New South Wales
• Victoria
• Tasmania

4
New South Wales

• Perisher
• Thredbo
• Mt. Selwyn
• Charlottes Pass

NSW, Australia photo
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Victoria

• Falls Creek
• Lake Mountain
• Mt Baw Baw
• Mt Buffalo
• Mt Buller
• Mt Hotham
• Mt St Gwinear
• Mt Stirling

On Snow Exams Falls Creek - Sept 2008
6
NSW Victoria
7
Tasmania

• Ben Lomond
• Mt. Mawson

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Medical Centre

• Some Patrols have
• Local Medical Centre (larger resorts)
• No Medical Centre (smaller resorts)

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Medical Centre

• Smaller Patrols are remote and are longer
  distances from a Medical Centre
• (several hrs by Ambulance)

• Some Mountains have Summer Recreation
  
• (Medical Centre are closed in Summer)

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Medical Centre

• Smaller Patrols are remote and are longer
  distances from a Medical Centre
• (several hrs by Ambulance)

• Some Mountains have Summer Recreation
  
• (Medical Centre are closed in Summer)

11
On Ben Lomond

• We are a minimum of two hours (round trip) from a
  Medical centre by Ambulance,

12
Extended Care Module

• Was the Brainchild of Peter Hoyle
• from Ben Lomond Patrol Tasmania
• (previous Captain 1992 to 2004)
• and
• ASPA VP Education 2005 - Now Retired.

Peter Hoyle
Ben Lomond Patrol HQ 2005
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Background and Intent

• The ASPA Advanced Emergency Care (AEC) Course
  trains Ski Patrollers to care for people injured
  on the Ski Slopes.
• In large resorts the patrollers duty of care
  ceases when they can hand over to the medical
  centre at the bottom of the slopes.
• In small resorts, (both alpine and
  cross-country), there is often no medical centre.
  Patrollers have the responsibility to care for a
  casualty until they can handover to Ambulance or
  other medical care, which may involve a wait of
  several hours or more.
• The ASPA project was to develop a module to
  provide general guidelines for Patrollers who
  have that extended care responsibility.
• It is not the intent to extend the patrollers
  competencies to paramedic level, but it will
  emphasize on important aspects of patient care
  that are within the competencies taught in the
  AEC Course, as well as focus on assistance to
  friends and relatives, evacuation of the casualty
  and interaction with medical personnel.
• It is envisaged that the module will be used as a
  resource for training at the patrol level, with
  local protocols added.
• The module was in its first draft prior to 2005
  season and was continued to be developed that
  season, with input from the Ben Lomond and Mt
  Mawson patrols,
• It was also hoped that Peter would go on the road
  in September, to Baw Baw, Mt Buffalo and as many
  other small patrols as possible to gain input,
  feedback and support .

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Feedback from other Patrols

• In September of 2005, Peter visited all of the
  patrols in Victoria Tasmania, and spoke with
  them on the concept of the ECM
• Objective to get feedback from members about
  their extended care issues.

Baw Baw Raul Picot, Paul Picot St Gwinear
Allan Wood, Craig Oldis, Andy Gillam, Mark
Connor, John Sunderland, Dr Margaret
Sunderland Lake Mountain Andrew Paul Mt
Stirling Peter Madden, Martin Burney, Mick
Stapleton Mt Buller Sam McDougall, Ossie
Ramp My Buffalo Chris Beach Falls Creek Glenn
McIlroy, Dr Mark Zagorski Mt Hotham Larry
Doyle. Ben Lomond John Marshall, Phil Harris,
Rocky Findlater, Dr Alex Thompson Mt
Mawson Andrew Davey, Liz Caldwell Mt
Selwyn Peter Mowbray
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Benefits Issues and feedback

• Medications
• Doctors bag medications
• Responsibility of supplying doctor
• Security, kept in a safe, key access limited,
  Patrol director or Mt Manager
• Some patrols will not have medications because of
  security concerns.
• Must be kept in date
• Records must be kept
• Patrollers should only have access to those
  medications for which they are certified
• There should be a minimum requirement for the
  facilities needed in a Remote Area first aid
  room
• Panadol should not be offered by Patrollers,
  but-
• If a patient asks for it, it should be readily
  available
• Nothing by mouth

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Benefits Issues and feedback

• Duty of Care Insurance
• Doctors who assist in the ski patrol should be
  sure that they are covered by their professional
  indemnity for good Samaritan voluntary work
• Standard advice sheets to give patients who are
  not ambulance cases
• waiver forms to be signed
• when does our duty of care end?
• Care Room Issues
• Toileting
• Output should be measured, test strips used
• Clean up and disposal of blood waste is important
• Peer Support and debrief strategies should be in
  place
• Abusive, uncooperative patient

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Benefits Issues and feedback

• Training
• ASPA should offer extended competencies, eg-
• O2 Nebuliser, Angenine, Sucking, Epipen, Gadel
  Airways, O2 Bagging
• Knowledge of specialized dressings, eg for
  abrasions, burns together with maintaining an A
  septic field is important
• ASPA AEC course concerns
• Length of attendance at the full course, 3
  weekends are difficult
• Can more competencies be tested at the patrol
  level by ASPA accredited assessors?
• Can the short course concept be extended?
• Can more of the course and testing be on-line?
• Agreement that the prac component should be
  maintained
• Pre course workbooks are good.
• More 4 day courses?

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Benefits Issues and feedback

• Ambulance
• Payment and patient refusal
• Advice on likely destination (which Medical
  Centre ?)
• When is an ambulance necessary?
• Briefing Ambulance Staff and handover
• Documentation - needs more information
• Form for doctors to use, their personal
  qualifications, history etc
• Every intervention should be recorded
• Abdominal girth to be recorded for internal
  injuries
• Oximeter readings.
• Changes in pupil size.
• Frequency of observations guide is needed
• Duplicate documents for both hand on and patrol
  records.

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Benefits Issues and feedback

• Other issues
• Patients need to be advised when surgery might be
  likely and anesthetics may be required.
• Who do you let go? What do you say or advise to
  the walk out patient who seems to have got
  better?
• Involving family and friends in what is going on,
  give them something to do, how do they feel?
  Dont cause unnecessary concerns or worry.
• Planning the evacuation from the hill as well as
  from the mountain
• Methods of evacuation
• Own transport car or Bus
• Ambulance
• Helicopter
• Returning gear and finding and advising other
  group members

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Managing Long Term Care

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• Planning the care from the time first Patroller
  arrives on scene

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• What are likely scenarios ?
• improve
• or
• deteriorate

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• How to keep Casualty calm and confident in our
  management their outcome
• What is going through their mind

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• How does the family or team members with them
  feel? Keep them informed. How can they help or be
  involved?

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• What evacuation plan?

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Australia Ski Patrol Association

• Thank you
• Peter (Rocky) Findlater
• Treasurer
• Australian Ski Patrol Association
• Captain - Ben Lomond Patrol
• PO Box 616
• FORTH Tas 7310
• treasurer_at_skipatrol.org.au
• Ph (home) [phone]
• Mob (priv) 0418128827
• Skype Name Rocky Findlater

Sandy Findlater with Ben Lomond Gnome
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Discussion paper - October 2005

• INTRODUCTION
• ASPA Emergency Care Course trains Ski Patrollers
  to care for people injured on the Ski Slopes. In
  large resorts the patrollers duty of care ceases
  when he can hand over to the medical centre at
  the bottom of the slopes. However in small
  resorts, both alpine and cross-country, there is
  often no medical centre. Consequently, patrollers
  often have the responsibility to care for a
  casualty until they can handover to Ambulance or
  other medical care. This may involve a wait of
  several hours or more.
• This module is intended to provide general
  guidelines for Patrollers who have that extended
  care responsibility. Operational protocols and
  details of equipment will vary between patrols.
• The module does not extend the patrollers
  competencies to paramedic level, but it does
  emphasize important aspects of casualty care that
  are within the competencies taught in the
  Emergency Care Course, as well as focusing on
  reassurance of the casualty, family and friends,
  evacuation and interaction with medical
  personnel.
• CONTENT
• Action to be taken when the casualty is brought
  into the First Aid room
• Introduction to the Ski patrol
• Explain to the casualty where he is
• Introduce yourself and others who will be carers
• Obtain permission to care for the casualty
• Vital signs
• Check DRABC
• Observe BP, Pulse, Conscious state, Skin
  condition, Temperature
• Determine frequency of Observations
• Recording
• Enter personal details, details of accident
  previous observations on the required Report
  Form.
• Accurately record all observations and actions
  taken.
• Secondary Survey