March 12, 2005


Staff training for my outdoor ed job started this week, and we talked a lot about tools and judgment. It reminded me of the many first aid trainings I've done, and how totally split they are between wilderness focus and front-country focus. The front-country courses - CPR, lifeguarding, the EMT classes I've heard about but not taken - are all about getting people to the damn hospital NOW. Preferably five minutes ago. You isolate body substances, you maintain potentially damaged spines in alignment, you perform CPR, but before you do any of those things you tell someone to call 911. The real treatment comes from the hospital.

There's a mentality that goes along with this that you should only do exactly what you've been trained to do, with the materials you've been trained on. My lifeguard instructor actually said, "You're only as good as your equipment," and told us about all the stuff he carried. Rescue masks, cravats, an arm splint, maybe even a blood pressure cuff. It's the lifeguarding tube that makes you a lifeguard, not your skills.

Since my primary training is as a Wilderness First Responder, I'm used to a really different attitude. It came out most clearly in my most recent recertification class, where we spent basically the whole time talking about bad situations where you don't have equipment or support and have to make the best of it. In a wilderness situation, you have to know how to splint people's arms comfortably enough for a 20-mile hike out, you have to make sure your patients don't get stressed because they're hungry or need to pee, you have to make judgment calls about what's really serious and what can wait. And your back-up is far away. You are the real treatment. You are also only as good as your head, your heart, and your ability. I think the idea that you're only as good as your equipment is utter bullshit: you can improvise cravats and splints out of t-shirts and sticks and do just fine. You can tell how people are actually doing without taking their blood pressure.

It's a totally different attitude, and I like it a lot better. Philadelphia Boss said he quit teaching Red Cross classes because it was basically a matter of teaching a bunch of morons not to fuck up. If that's what you teach people, it's not surprising that they follow protocol and nothing else.

Now I'm going to get out of bed and celebrate the fact that I don't have to work 14 hours today.

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