First Aid Memories...

A few months back, I had to do my OFA 3 examination.  Basically, an OFA is an Occupational First Aid course, and level 3 is the highest level possible for that category.  It's a level of first aid that's the highest possible in the workplace, but still a bit short of what your entry-level paramedic has (I take that course in november). 

So, I'm doing my practical examination.  During exams, you are given a situation, and one of the other people taking the test gets to be your victim.  You go through the usual first aid procedure, while the examiner watches your technique.

My situation involved a man that fell thirty feet from a scaffold, hitting the concrete wall as he fell, before landing on a piece of rebar that pierced his lung.  Before I get there, he has pulled himself on the rebar, and is sitting straight up, with his back against the concrete.

I won't go through the entire situation, because it's fairly boring stuff - I talk to him, assess his airway (all clear, but I'm told there's a bubbling from his chest by the examiner, and his breathing is awful), block the hole with my hand, and get him to lie down while immobilizing his neck. 

While doing this, my victim (who is supposed to be totally quiet) whispers to me "Dave.  You didn't do that right."

Apparently, I didn't have a tight enough grip on his neck when I was lowering him - after all, I had to have one hand blocking his chest, right?  But, I glare at him, and whisper back "Be quiet.  We can get in trouble"

So, I'm a little frazzled now, wondering if I actually had lowered my patient incorrectly (I had, but only technically - in practical terms, it was fine... I was told this later by the instructor).  But I go through my assessments, and get a helper to keep a hand on his chest.  When I do my ABCs (Airway/Breathing/Circulation), I find he's getting better.  As part of my assessment, I'm also joking around with my patient, and my examiner tells me my manner is calming the patient down.  Bonus points for me.

(I think one of my jokes was "hey, look at this way - people usually have to pay money for a piercing like that.  You're the most extreme construction worker I know")

I'm just beginning to get my nerves back when I start packaging the patient for transport to a hospital. I'm taking the velcro straps and tightening his body to the spine board, being extra-careful to make sure they're tight enough (this was my worst area in actual training). And then my patient whispers again.  "Dave!  You haven't bandaged my wound!  You have to do that first"

Which takes me out of my groove again.  You see, when you have someone that has the exact same level of training as you, telling you you're doing something wrong, you have to seriously consider the possibility he's correct.  Also running through my mind is the fact that, if the examiner catches my patient helping me along, we can both get kicked out of the examination with an auto fail.  It's happened before.

I'm a little pissed off, naturally.  "Shut up.  Shut up.  Don't help me, please.  You'll get us both kicked out."

He glares back at me, giving me a "I was only trying to help" face.  The examiner sees this, realizes what's going on, and says "Lxxxx, don't help, please." 

Now I feel like this is an obvious clue that I've missed something.  Oh, shit.  It's about all I can think.  I was about to package this guy, without bandaging the gaping hole in his chest.  In my mind, I'm thinking "well, he's Rapid Transit, so we need to get him to the hospital.  I do have the hole plugged, but is my helper going to fit in the ambulance with me?  He is getting better... should I bandage this now?"

So, I bandage the wound.  And, by the way, I was later told that I bandaged it perfectly. 

But because I bandaged it there, and not in the ambulance, I nearly failed the scenario.  The only thing that saved me was my explanation to the instructor on WHY I bandaged the wound there (normal vitals, no severe bleeding, sufficient helpers present, and the fact that a fix here would make things much easier for me in transit).  And the fact that she could tell my victim was a douche.

Did I mention that he was fifteen minutes late for the examination, and very nearly wasn't allowed in? 

"Between you and me..." she said to me, when we were going over my scenarios, "I would have tightened his straps over his mouth." 

"Can we do that?" I ask, grinning.

"At least he wouldn't be able to tell you that you can't."