# Using Basic or Advanced First Aiders vs. MFRs and EMTs at a Recreational Facility



## Mountain Res-Q (Aug 17, 2009)

Okay, so I have a logistic/standard of care question for all you folks… one that I would appreciate some constructive suggestions on:

As you may or may not know, in the winter I am a Manager/EMT for a local Snow Park that specializes in Snow Tubing.  We have lifts, $120 inner tubes, the steepest tubing hill in CA, and many other “resort” type amenities.  Obviously our clientele is largely people visiting the snow; people without the “skills” that patrons of Ski Resorts have… therefore the place can turn chaotic and dangerous VERY FAST… that is where I come in…  I (along with one other person) manage the “Office of Park Safety”.  We have a large number of employees working under us and we ensure the safety and security of the customers.  Even if all my "safety employees" do their jobs 110%… accidents happen, so part of my staff includes EMTs and MFRs.  We deal with a lot of soft tissue injuries, fractures/dislocations/muscle injuries, spinal injuries, and the occasional medical issue (usually precipitated by the physical activity) such as seizures, MIs, or pregnant women with syncope.

Here is the problem:  

Staffing!  I usually have enough employees every year to staff the tows, the parking lot, security, hill safety, etc…  But have a hard time finding enough EMTs and MFRs.  Some years we have enough (barely)… but most years, we have a hard time covering the entire schedule with enough EMSers.  One memorable year in particular:  It was me and one other EMT for the entire season (with a FF Explorer with first Aid to assist us)… that was really bad when we had a “MCI” and had 3 pts. and only 2 EMTs.  (FYI vollie FFs are 25 minutes away and ALS ambo is 45 minutes away.)  We have tried everything to get more EMS staff… great pay… great perks… targeting newbies fresh out of school… targeting vollie FFs…  offering to pay for returning employees to take MFR… EVERYTHING…  

So, we have an idea that we are mulling over… can I get you input?

I want to organize classes for select employees that I believe have a higher degree of capability.  We want to organize a 16 hour Title 22 First Aid class and a 8 hour Professional CPR/AED class.  For those of you who are unaware, Title 22 First Aid is a CA EMSA recognized provider level that is basically Advanced First Aid and includes basic supplemental O2, c-spine/backboarding, and a variety of other BLS information/skills.  Title 22 in CA is the level of certification that all LEOs and Lifeguards must maintain.

My question is, assuming that there was a least one EMT on duty, do you think that (under the circumstances) this plan makes sense?  What would you do in my position?  Is Lifeguard First Aid “good enough” with an EMT (myself) overseeing the overall medical operations?  With this idea as a target goal, we have to convince the owners that we “have to” do something like this, which may mean starting off by simply training people to a Lay First Aid / Lay CPR standard (8 hours) for the next season… is this a good idea to have Basic First Aiders working under the direction of an EMT?  My plan would actually be for me to get the certification to teach and certify to these standards, as long as the idea makes sense to all involved…  However, before I bring this issue/plan to the Park Owners, I would appreciate the opinions of fellow EMSers that know a thing or two…  so…

Comments?  Suggestions?  Questions?  What would you do?  What should I do?


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## Shishkabob (Aug 17, 2009)

Obviously, the more ACTUAL EMT's (B/I/P's) the better... but:

You could always do a mini-MICU style thing... one advanced provider and one lesser provider, but instead of being a medic/basic, it's a basic / first aider.  I guess the "every patient deserves an advanced assessment" argument can be inserted here, even if the "advanced" assessment comes from a Basic.


Obviously, it depends on your companies policies and medical control / what they allow and not allow people to do.




And finally, the less certified a person is, the more YOU have to educate them.


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## NomadicMedic (Aug 17, 2009)

Not able to speak to your specific question, but a good place to start would be the risk management company that handles your facility.

I work for a large water park as an EMT, and while we have a HUGE number of trained lifeguards on duty, we also must have several EMS providers on site anytime the park is open to guests. This is a mandate of the insurance company/risk management folks.

Before doing anything, I'd find out what your facility requires in the way of training and staffing.


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## Mountain Res-Q (Aug 17, 2009)

Linuss said:


> Obviously, it depends on your companies policies and medical control / what they allow and not allow people to do.





n7lxi said:


> I work for a large water park as an EMT, and while we have a HUGE number of trained lifeguards on duty, we also must have several EMS providers on site anytime the park is open to guests. This is a mandate of the insurance company/risk management folks.
> 
> Before doing anything, I'd find out what your facility requires in the way of training and staffing.



Medical Control?  As a private facility/business, we are not "controlled" by the county EMSA, although all MFRs and EMTs that work here are required to maintain cert from the county and follow county BLS protocols (there is no FA county protocols).  But we do not report to anyone and our paperwork does not go to the county unless we transfer the pt to the ambo... then we get them a copy in oder to maintain an informed transfer of the pt from provider to provider (not because we have to)...

The insurance company/risk management, is a valid point, and I will have to look into that.  We are not required by anyone to have any medical care on site, but obviously the owners found it to be a good idea when they opened the park up 19 years ago... and history has proven that it is a good idea.  We (including me) have to deal with the insurance/liability folks all the time... they want to raise rates and we keep fighting them, as is evidence by the large amount of "safety staff" I manage.  I know that the fact that we have MFRs and EMTs on site lowers our rates, but we have never been told that we have to have EMTs on site... in fact before I was working there, there were slow-midweek days when there was no medical staff on site.. something that will NEVER happen again under my control...  which is why I am looking into the idea of "Lifeguards" backing up EMTs (not replacing).


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## frdude1000 (Aug 17, 2009)

I think thats a great idea.  Maybe you should get some more first responders.  It only 60 hrs and their are classes that are only 10 days.  Title 22 is ok, but make sure you do alot of refreshing and drills/training for them, and everyone else.  Also, go over how they can assist the mfr/emts and practice the most common situations.  Are their ski slopes?  Is their lodging?


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## Mountain Res-Q (Aug 17, 2009)

frdude1000 said:


> Are their ski slopes?  Is their lodging?



Kinda sorta...  while I am not a big fan of the website, here it is...  it obviously minimizes the risks involved in hurling yourself down an icy hill at 25-30 mph on a innertube without steering, breaks, a seatbelt, helmet, or any control devices...  and makes no mention of the safety of medical staff... but here it is...

http://www.snowplay.com/

plenty of cabin rentals and motels around... but not assosiated wiht us.  We have a lodge, with an arcade area, snack bar area (burgers, dogs, chile, soups, cocoa, etc...), and so forth...

We have tows that take customers to the top of the hill/slopes.  We have 3 hills with divided lanes/runs.  the main (larest hill) has 10 runs.  The medium hill has 3 runs.  The kiddie hill has 4-6 lanes.  Quite frankly, I don't see the thrill, but we are packed every Saturday, Sunday, and Holiday... so, we need a fully staffed medical unit on those days...


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## frdude1000 (Aug 17, 2009)

Are people suspended in air on the lifts, or do you hold on and it pulls you up?  What are the statistics?  How many people do you backboard a year?  Is their a first aid room.  What kind of supplies do you carry?


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## Mountain Res-Q (Aug 17, 2009)

frdude1000 said:


> Are people suspended in air on the lifts, or do you hold on and it pulls you up?  What are the statistics?  How many people do you backboard a year?  Is their a first aid room.  What kind of supplies do you carry?



Sit in the tubes, are hooked on to the lifts by operators, sit still, are detatched automatically at the top...

Stats?  The boss man refuses to reveal that to anyone for fear that we find out what he grosses in a year    but on average (at any given time) we (staff) is outnumbered 1 to 100 on the hill.  Injury stats?  Depends on the day and the type of injuries...  But, I can say that a good portion of my days are spent writiing and reviewing other peoples paper work.  A lot of minor FA stuff (ice burn, cuts, scrapes, pains)  and a decent amount of actually BLS trauma stuff... heck had a vehicle rollover in the parking lot this last year with a pregnant woman in the car!  Backboarding skills are a must... but we also see things like MIs from all the snow play and siezures when people have hit their heads on the snow when coming down the hill...  I couldn't tell you off teh tp of my head how many backboardings in a year, it ranges... and last year was kinda mild...

First Aid Room?  Yes... fully equipped to a BLS level...


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## mycrofft (Aug 17, 2009)

*As always, what is the standard?*

Just because you are not public does not mean you are not subject to prehospital provider regulation by SOMEONE, not to mention insurance and legal considerations. The "community standard" and "reasonable practitioner" standards always apply, if you staff or train below the surrounding facilities you are already on the black diamond slope.

As tantalizing as it seems, training up your own posse is probably not the answer. Upgrading your extant staff's level of awareness is neat, the biggest things you can impart to them being how to initiate emergency care and what NOT to do, but you still need those certificates and licenses.

Advertise at the local facilites training EMT's. Advertise HERE. Check with local (central Calif) Scout councils and Explorer posts, see if they have or know of people needing the work who they have used for their people skills etc. Local vollies probably include some guys and ladies out of work.


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## JPINFV (Aug 18, 2009)

The big issue with amusement park first aid is the fact that we lose the safety net of all patients going to the hospital. If first aid is being manned by a minimum of an EMT with experience and good assessment skills, then it makes sense to supplement the response capability as much as possible with first aid trained responders. For example, when I was working at a water park I was generally the only EMT-B at the park which averaged about 6-7k visitors per day. Now every supervisor and life guard was trained in CPR, first aid, supplemental oxygen, and spinal immobilization and could provide immediate response if needed while I was enroute to the location.


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## Mountain Res-Q (Aug 18, 2009)

mycrofft said:


> Just because you are not public does not mean you are not subject to prehospital provider regulation by SOMEONE, not to mention insurance and legal considerations. The "community standard" and "reasonable practitioner" standards always apply, if you staff or train below the surrounding facilities you are already on the black diamond slope.
> 
> As tantalizing as it seems, training up your own posse is probably not the answer. Upgrading your extant staff's level of awareness is neat, the biggest things you can impart to them being how to initiate emergency care and what NOT to do, but you still need those certificates and licenses.
> 
> Advertise at the local facilites training EMT's. Advertise HERE. Check with local (central Calif) Scout councils and Explorer posts, see if they have or know of people needing the work who they have used for their people skills etc. Local vollies probably include some guys and ladies out of work.



I agree that finding certified EMTs and MFRs is the way to go... but trust me, it ain't that easy to find them and i have tried every means I know of...  Fire (paid and vollie), forest service, SAR, Ski Patrollers, retired EMS, and even newbies fresh out of school...  little to no luck!  The issue is that we need local people as no one wants to drive 2-3 hours (half in snow) to get to a seasonal EMT gig, no matter waht we pay and provide.

And for the record, we are not "training our own posse".  I am looking at providing official certificating classes to select employees that display an apptitude to "not screw up".  The level of classes I would like to provide is MFR or similar (but that may not be possible right away)... therefore I am looking at the Title 22 First Aid thing... whihc would mean that we could be staffed with Lifeguards and EMTs... just like a Water Park, which I consider us to be; a winter water park or snow park.

I have yet to see any set standard for Snow Park Medical Staff.  In fact, neither the county or our insurance require it to be in operation... I am just trying to provide the best care for our customers since BLS vollies are 25 minutes away and ALS ambo is 45 minutes away, and they don't need to be bothered with non-transporting injuries and issues (how many people does a Ski Resorts patrollers deal with in a day versus how many they have taken out on ambo).  That is why the thought behind a "Lifeguard - Advanced First Aid" staff backed-up by us few EMTs makes sense to me... not the best option, but as so many here are fond of saying "EMT_ is _just First Aid"...  :glare:



JPINFV said:


> The big issue with amusement park first aid is the fact that we lose the safety net of all patients going to the hospital. If first aid is being manned by a minimum of an EMT with experience and good assessment skills, then it makes sense to supplement the response capability as much as possible with first aid trained responders. For example, when I was working at a water park I was generally the only EMT-B at the park which averaged about 6-7k visitors per day. Now every supervisor and life guard was trained in CPR, first aid, supplemental oxygen, and spinal immobilization and could provide immediate response if needed while I was enroute to the location.



That is what I am thinking...  Title 22 First Aid is a CA EMSA recognized level of EMS provider... so why won't that work and be legal?


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## Melclin (Aug 18, 2009)

I'm surprised you can't find anyone. The seasonal stations at ski slopes here are staffed by medics from the state ambulance service, and you basically have to duel with pistols at dawn to get seconded up there. 

I thinks it's a great idea to train you're own posse. Obviously I don't get all the legal crap that you guys have over there, but the idea of sending lots of employees off to first aid/CPR/AED class is a good one. You have to do that for just about any job working with groups of people here (school teachers, swim teachers, sports coaches etc). It's a good level of basic education for everyone to have anyway (first aid and CPR is taught to students in schools now, many employers send their employees off on personal development days that include first aid/CPR even for office workers etc.), and if it means they could help you spread your better trained staff, then that seems pretty clever.


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## mycrofft (Aug 19, 2009)

*That's not as bad as I was thinking.*

Are those winter response times?

Maybe need to sweeten the employment deal, provide housing (I accidentally typed "hosing" knowing the winter rental rates!) or a housing allowance and maybe finding them lodging with amenable locals?


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## Mountain Res-Q (Aug 19, 2009)

mycrofft said:


> Are those winter response times?
> 
> Maybe need to sweeten the employment deal, provide housing (I accidentally typed "hosing" knowing the winter rental rates!) or a housing allowance and maybe finding them lodging with amenable locals?



Response times depend on the weather.  Closest ALS Ambo Station is 25-30 miles away... so if they are in quarters when the call comes through...  35-45 minutes in really good weather... but as much as 75-90 in bad.  Vollie BLS Fire is 10 miles away, so depending of staffing and availability... 20 minutes (at best) to 45 minutes.  But, the vollies can't do anything I can't and I will not reliquish pt. care (completely) to them until a Medic gets there.  They can evaluate all they want... but it is my First Aid Room, my supplies, and I have already treated to the extend they can...

Housing...  not really possible...  First of all, this is by no means a Full-Time gig for anyone except myself and few other Managers.  We are slammed on Saturdays, Sundays, and Holidays, but midweek (unless we have scheduled groups) is another story, where even at minimal staffing, we are lossing money.  So this job, for most is a 3 day a week gig, with the possibilty for 4 or 5 days (or more) during Christmas Break, Spring Break, and Ski Week.  This is why this job works so well for students, because we can (and will) work around school schedules.  Last year we had a Fire Science Student that was also taking LVN classes...  and we worked around it as long as we can get that weekend/holiday help (when we need it)...  so housing for something that is really a Water Slide Park tht operates when kids are in school (not in summer), eh...  Owners wouldn't be up for that in addition to everything else we do for them.  Consider the "perks" and then give me a call if you want another Job this winter ^_^:

Pay:  Most emplyees:  $9-10 and hour... Medical Staff: $10-12 depending on the person (with the posibility for more)...  for reference, Ski Patrol EMTs up here start at $8-9 and ambo EMTs start at ~$10.  So we pay more!

Food Allowence:  2 Free meals a day!  Breakfast (Bacon, Hashbrowns, Fried Potatos, Sausage, Ham, Biscuits and Gravy, Eggs, Breakfast Burritos, etc...) and Lunch (Burgers, Dogs, Burritos, Soups, Chili, Sandwiches, etc...).  In addition, we supply you with all the Drink and Snacks you need through the day (Water, Soda, chips, cookies, candy, and even a beer or two at the end of the day).

Clothing:  Free Snow Boots, Snow Pants, Beenies, Snow Socks, etc... for thoe employees that are not well suited for the snow.

Schedule:  I mentioned that we will work with anyone that is willing to work, at the very least, Saturdays.

Transportation:  We arrange carpooling for those that need it and we (managers) will even go out of the way to pick employees up for work.

Other Perks:  FREE Lift Passes for all employees and all immediate family... and we will even extend that out to include friends if we feel so inclined (and we usually do).  On really snowy/blizardy days, when we have to work the follow day... some employees have been know to stay at the Lodge, Office/First Aid Room Area, or at the Owners condo up the road... for free... we food provided by the owner (such as a short trip down the road for tri-tip, steak, or pizza)... on the bosses dime...

Although we still have to deal with stupid tourists that should be left to Darwinism... who wouldn't want to work here?  And in all honesty, we can usually find enough employees for everything else that falls under my control (tows, hill safety, hill monitors, parking, security), but not Medical...  :sad:

Which is why I am at the point where having "Lifeguards" with Advanced First Aid (CA Title 22) backed up by MFRs and EMTs makes sense to me...  It would be like a Water Park, with Lifeguards monitoring the day to day activities and being your "First Responders" for any medical issue, with EMTs 2-5 minutes behind them...  and considering the response times of Fire/Ambo, tht still seems like a reasonable setup.


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## hottrotter18 (Aug 19, 2009)

Mountain Res-Q said:


> Food Allowence:  2 Free meals a day!  Breakfast (Bacon, Hashbrowns, Fried Potatos, Sausage, Ham, Biscuits and Gravy, Eggs, Breakfast Burritos, etc...) and Lunch (Burgers, Dogs, Burritos, Soups, Chili, Sandwiches, etc...).  In addition, we supply you with all the Drink and Snacks you need through the day (Water, Soda, chips, cookies, candy, and even a beer or two at the end of the day).



Im sold!!
where do i sign?


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## Mountain Res-Q (Aug 19, 2009)

hottrotter18 said:


> Im sold!!
> where do i sign?



Send my copies of your certs and you are hired!!!  

Oh, and I failed to mention the nachos... my weakness...  :blush:

AND just an understanding of what Title 22 First Aid is...  It is the minimum requirements for ALL Peace Officers, Firefighters, and Lifeguards in California:

California Code of Regulations
Title 22. Social Security
Division 9. Prehospital Emergency Medical Services
Chapter 1.5. First Aid Standards for Public Safety Personnel

http://www.emsa.ca.gov/laws/files/psregs2000.pdf


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## Mountain Res-Q (Aug 19, 2009)

frdude1000 said:


> Are people suspended in air on the lifts, or do you hold on and it pulls you up?  What are the statistics?  How many people do you backboard a year?  Is their a first aid room.  What kind of supplies do you carry?



These are all from DEAD days (midweek).  On a Weekend, the hills are full of people, all seemingly intent on killing one another...  :glare:  Injuries at those speeds, and on compacted snow and ice can be pretty cool...  ^_^

FROM THE TOP

[YOUTUBE]http://www.youtube.com/watch?v=M_aGPFNgAz8[/YOUTUBE]

FROM THE BOTTOM:

[YOUTUBE]http://www.youtube.com/watch?v=s1XXyO5FpRY[/YOUTUBE]

FROM THE TUBERS PERSPECTIVE.  The fella in the red jacket walking past is on of our medical folks that was kind enough to give a hand.

[YOUTUBE]http://www.youtube.com/watch?v=OiGVkygr6gM[/YOUTUBE]


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## RMSP05 (Aug 19, 2009)

I am surprised that you can’t find people if you offer that many perks.  What if you offered people bonuses, or tuition reimbursement for working there.  Or maybe try increasing you base pay.  If I lived out there, you would have me sold with your offers.


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## Luno (Aug 19, 2009)

*Similar, yet different*

Watching your videos, it is a similar idea to one that we operate.  That being said, we generally do not have the incident level to justify more than one medically trained responder.  However emergency incidents are responded to by Ski Patrol, and there are up to 40 patrollers at the area.  I believe our incident count from last year was under 25 for a 4 month season.  We also operate at full capacity with 15+ lanes, however there is a different model, as there are 2 hour "windows" that tickets are good for.  That causes a completely new group of patrons every two hours.  Our average incident was primarily slip and falls, with two concussions, various facial abrasions, and one or two broken bones.  That being said, we do take our liability and safety concerns a little different.  There are strict rules regarding patron conduct, and risk taking, including not more than one tubing patron per lane per time, etc...  Anyway, good luck with this...


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## Mountain Res-Q (Aug 19, 2009)

Luno said:


> Watching your videos, it is a similar idea to one that we operate.  That being said, we generally do not have the incident level to justify more than one medically trained responder.  However emergency incidents are responded to by Ski Patrol, and there are up to 40 patrollers at the area.  I believe our incident count from last year was under 25 for a 4 month season.  We also operate at full capacity with 15+ lanes, however there is a different model, as there are 2 hour "windows" that tickets are good for.  That causes a completely new group of patrons every two hours.  Our average incident was primarily slip and falls, with two concussions, various facial abrasions, and one or two broken bones.  That being said, we do take our liability and safety concerns a little different.  There are strict rules regarding patron conduct, and risk taking, including not more than one tubing patron per lane per time, etc...  Anyway, good luck with this...



We are not affiliated with any ski facility, therefore no other medical help is available from Ski Patrol or such... just us,  and if needed... vollie MFR FFs.

As for our incident numbers...  from what I have seen from other similar places we get a larger number of customers and our customers are primarily ghetto folk from the central valley and from the bay area...  both mean that we get a lot of rule violators and just really stupid behavior that increases the incident numbers.

As far as rules go... since my reign of terror, we have really gotten strict and things like more than one person in a lane at one time are NO LONGER ALLOWED...  I hasve gotten really mean about it, and am all too happy to kick people out.  ^_^  

Like you, we have the 2 hour ticket option, but also have the all day pass since we get those people who show up at 0900 and tube, snowman, tube, snowballfight, tube, eat, tube, arcade, snowball fight, tube... all day long.

Our injuries appear to be more severe than yours...  a lot of potential spinal issues, fractures/dislocations, cuts, bumps, bruises, ice burn, and other medical issues...  The "oddests" ones for me at a Snow Park where you expect just sports related injuries:  Siezures post head colliding withe the snow (several by the time the helo was landed), an MI after climbing to the to of the hill to get a picture (odd presentation that threw me for a loop), and an MVA in the parking lot involving a pregnant woman...


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## mycrofft (Aug 19, 2009)

*Need a new service:*

"Tube Patrol"!


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