Core (but rarely used) skills

[dixie_flatline]

Trying to put together a list of important skills that are rarely used, that we can do during monthly drills to keep people fresh (mixed volunteer fd).

This stems from a recent spike in calls to our local park for pee-wee football "possible head injuries". One of the skills that is gone over, briefly, in Basic class is spinal immobilization of someone in a helmet. We are going to work with a local coach to get some pads and helmets we can actually cut/disassemble to practice on. What other skills are used once in a blue moon, but need to be sharp? We already practice regularly with setting up the peds unit on the cot, even though it is rarely used.

(Aside: all the NFL attention to TBI is really increasing parental awareness from what I've seen. Calls are up exponentially for this).

 

[usalsfyre]

Spinal immobilization isn't a skill I think is particularly important in any setting. If your immobilizing football injuries you should be leaving the pads and helmet on and simply cutting the facemask away at the plastic attachments.

Airway. Airway. Airway.

Most providers of all levels suck at basic level airway management. I'd start there.

 

[MedicBender]

+1 on airway

Also consider splinting, especially traction splinting.

I've done a couple sessions with the KED as well. The last few EMTs I precepted out of class weren't even taught how to use the KED.

 

[AlphaButch]

Airway +1 - Learn how to remove the face mask w/the helmet still in place. Either use a screwdriver or some shears (your trauma shears may not be strong enough, heavy garden shears work).

Also reinforce Concussion/TBI Assessment skills and protocols. Include distracting injuries into the training.

/Working on getting concussion certification courses accepted down here in TX due to the new Natasha law.

 

[Handsome Robb]

Spinal immobilization isn't a skill I think is particularly important in any setting. If your immobilizing football injuries you should be leaving the pads and helmet on and simply cutting the facemask away at the plastic attachments.

Having been through a cervical injury while on the field and being strapped to a backboard in full pads I can tell you first hand it is not comfortable. With that said good luck getting properly fitted football equipment off without compromising the spine. So x2 to what usals said.

 

[silver]

Airway +1 - Learn how to remove the face mask w/the helmet still in place. Either use a screwdriver or some shears (your trauma shears may not be strong enough, heavy garden shears work).

Also reinforce Concussion/TBI Assessment skills and protocols. Include distracting injuries into the training.

/Working on getting concussion certification courses accepted down here in TX due to the new Natasha law.

They make devices, like trainer's angel or face mask extractor, that are designed with the sole purpose of removing the mask. They can be very useful. However, they can be very expensive and you might not ever use them. If you do a lot of standbys at games it might be worth while getting. A more economically friendly idea is asking teams/trainers to make sure that they buy them and stock them in their FA/trainer kits.

 

[fast65]

I'm going to agree with airway as well, especially how to get a proper face-mask seal, so many times I see this done improperly. It's not a rare skill to perform, but it's something I feel deserves to be practiced.

 

[abckidsmom]

Airway and stretcher operations.

Right behind usalsfyre on the fact that providers across the board at many levels SUCK at safely moving people every. single. time. on the stretcher. Like totally.

So, every person needs to be taught to walk with 2 hands on the stretcher at all times, raising and lowering with a partner, by yourself, navigating through tight quarters, what is the maximum safe number of stairs you can take the stretcher up, positioning tricks, and loading the stretcher by yourself.

This is such a foundational skillset that so many people are never given formal training on at all. An untrained person on the foot of the stretcher is scary, and worse than useless.

 

[firetender]

When least expected...

...throw in head-to-toe evaluations. You can never get enough practice.

(HINT: "Insert" a specific injury/injuries into the Subject, for the Medic to "find.")

 

[IRIDEZX6R]

Either use a screwdriver or some shears (your trauma shears may not be strong enough, heavy garden shears work)

haha sounds like you need better shears. Mine cut through sheet metal, but then again they cost me 80$

 

[IRIDEZX6R]

Hmm... Core skills.... hmm, how about the little things that my partners can't even do right? Like taking V/S. Or using a gurney. Or driving. Using a thomas guide. I've always noticed all my partners can never strap a backboard...

 

[Chief Complaint]

Trying to put together a list of important skills that are rarely used, that we can do during monthly drills to keep people fresh (mixed volunteer fd).

This stems from a recent spike in calls to our local park for pee-wee football "possible head injuries". One of the skills that is gone over, briefly, in Basic class is spinal immobilization of someone in a helmet. We are going to work with a local coach to get some pads and helmets we can actually cut/disassemble to practice on. What other skills are used once in a blue moon, but need to be sharp? We already practice regularly with setting up the peds unit on the cot, even though it is rarely used.

(Aside: all the NFL attention to TBI is really increasing parental awareness from what I've seen. Calls are up exponentially for this).

Are you making a list for BLS skills only?

I think its been said but i think that AED/airway skills should always be a part of your training. Many people riding on BLS units dont get to use them because ALS usually gets the call. Not sure what your protocols are but keeping your guys and gals familiar with the King Airway is very important. Its an easy skill, just something that doesnt get dont too often by BLS providers.

AED as well. You would be amazed how quickly such simple information leaves the brain if it doesnt get used. The differences between a witnessed vs unwitnessed arrest are very important to know.

Going back to airway, ensuring that your staff is capable of forming a tight seal while using the BVM, very important stuff.

To be honest, at the Basic level, i think almost all skills should be practiced repeatedly. You usually dont get to use them on a regular basis.

 

[Handsome Robb]

Not sure what your protocols are but keeping your guys and gals familiar with the King Airway is very important. Its an easy skill, just something that doesnt get dont too often by BLS providers.

Protocol for arrests in my agency is Medic takes airway via King and EMT drills an IO. If I work with an medic for an extended period we end up alternating.

Like you said, King is an easy skill but like anything, if you don't use it you'll lose it.

 

[systemet]

* Managing a delivery, including abnormal presentations. There's about as much BLS can do here as ALS in most situations.

* Neonatal resuscitation. No reason why BLS can't follow the first minute of NRP.

* Triage / MCI plan review.

* Review arrest management in special situations, e.g. peds, penetrating trauma, hypothermia. BLS needs to be up to speed here.

* Agree 100% with BVM / basic airway management skills.

 

[Chief Complaint]

Protocol for arrests in my agency is Medic takes airway via King and EMT drills an IO. If I work with an medic for an extended period we end up alternating.

Like you said, King is an easy skill but like anything, if you don't use it you'll lose it.

Wow, the IO is a Basic skill in your agency? Im not against it, ive just never heard of a place that operates like that.

 

[mikie]

wow

Protocol for arrests in my agency is Medic takes airway via King and EMT drills an IO. If I work with an medic for an extended period we end up alternating.

Like you said, King is an easy skill but like anything, if you don't use it you'll lose it.

Maybe I'm wrong here but doesn't this seem a little backwards? Many agencies allow their BLS providers to drop BAIDs (Combi, King, PTL, LMA, etc) but wouldn't dare letting them near an IO (yes, i know there are a few exceptions). I know IOs are not very difficult procedures, I just don't feel comfortable with someone with ~120 hours of training to be drilling holes in bones...

Are you private, fire dept or EMS agency based, etc?

 

[dixie_flatline]

Thanks guys for the suggestions. We do monthly EMS training (I'd prefer more but they do Fire and Rescue training the other weeks), and we go over Assessments, AED/autopulse use, and airways/O2 pretty regularly. It's the stuff that never gets used (until it does) that I was trying to make a list of. Neonate stuff is actually pretty good, as the station down the road just had a baby delivered BLS the other day I believe.

mikie, if you were asking me, i'm in a mixed career/volunteer fire dept (on the vollie side).