1. #1
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    Question "Live Victims" in Vehicle Rescue Training?

    Not to start an argument here... Just looking for ideas / opinions...

    What is anyone doing in regards to using live victims in vehicle rescue training? I am currently working on developing a policy / guideline in this regards. A few things that I have already included is the use of multiple ISO's; a checklist of potential risks that need to be addressed; the use of extensively trained vehicle rescue and EMS personnel as "victims", and how students, instructors and evaluators are briefed prior to the training.

    I have reviewed NFPA 1041, 1500, and 1670 and none of them specifically prohibit this, as they do in live burns.

    I personally believe that this training is invaluable, and makes the students more conscietious when they approach the training scenarios (...not just straw filled dummies in the car...). And the live victims are only used in the last phase of the training after the students have received all the other necessary training.

    Anyone with thoughts or ideas???

  2. #2
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    We have used live victims in our trainings many times. Usually when we do this we have several cars and will let one group practice on just a car for technique, simple extrication for patient handling and finally one to put it all together. The victim will have PPE, eye protection, and a blanket over them during the use of tools. However if its going to be difficult or training new members we will have someone sit in the car, let the crew size up the scene, form a game plan and right before they start to cut we pull the victim. When their done w/ tools we reinsert the victim and allow them to do the extrication. The use of victims is exclusivly left up to the officer in charge of the training.
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    Don't use a live person when a dummy can work. If you want to have someone evaluate the removal of the pt then pull the dummy out and replace it with a person after the extrication is over. "Firefighter Victim injured in extrication drill" isn't a headline that anyone should see.

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    Stay tuned to the Firehouse magazine- Ron Moore is about to release an extremely comprehensive (and excellant!) article in relation to organising MVA training sessions and policies and procedures for you to follow to ensure everyone's safety. (Maybe also prevent the dreaded "lawsuit" if something was to go wrong....)

    Dependant on the type of evolutions being practised, I do advocate the sue of live victims. It's a big can of worms- get ready for a bit of hot debate on this!
    Luke

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    In our rescue training courses we use the trainees themselves as victims in the final extrication scenarios.
    There is no other way to enable rescuers to fully appreciate the sights, sounds and feelings of the victims they are trying to help.
    Of course every possible safety precaution must be taken but at a real rescue situation we are charged with keeping the victims, ourselves, other emergency service personell and bystanders safe from all and every reasonably predictible harm.

    Keeping one of our own safe during live training evolutions in order to gain a complete picture of the effects of their actions should not be too tall an order
    Jim Maclean. IACOJ NZ branch

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    We have used live "victims" in vehicle rescue training, both fire/EMS personnel and local high school students during prom night/MADD sponsored evolutions. As many hazards as possible are mitigated prior to placing anyone in the vehicle. Glass, batteries, and fuel tanks are removed, any existing sharp items are covered or removed, radio antennas are taken off (very easy to get poked in the eye, right under your safety glasses), and all types of patient protection are utilized, including extrication blankets, short boards between door panels and victims, hearing & eye protection, etc. We haven't injured a "victim" yet, and are as careful as possible to never have an injury. I think the experience is good for both the rescuers and the "victim" - after all, when we do this for real, we shouldn't be causing furthr injury to the victim, right? I think the mantra is "Above all, do no harm". Plan well in advance - there is no hurry when you're at a drill. And remember, when it's for real, you'll fall back on your training, not rise to your level of expectation. If you train to be careful about not causing further injuries, you'll operate that way on the street. Be safe out there!
    R.A. Ricciuti
    Mt. Lebanon Fire Department

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    We also use "live dummies" during many of our extrication exercises. The subject vehicles are almost always on their wheels, or on their sides. If a vehicle is on its side, then it is well cribbed and chained before the "patient" enters. Also, extreme care is given to the use of tarps, full PPE, dust masks, eye protection and ear protection for the vehicle occupants.

    The whole point of the use of live dummies is for the FR who is responding, than it is for the actual extrication techinque. With a live patient, the FR is able to interact with him/her, and also it gives for real time responses to ensure proper patient care and handling techniques are used.

    Some of the more common questions that I ask when doing the FR work would be: "During the spinal imobilization and extrication, did your head feel like it moved any? Or did it move a lot? Did you feel that you were safely removed from the vehicle?" When you have a patient in the field, sometimes they are not really able to communicate effectively to answer any questions that I might have regarding how well "I handled" them. I find the feed-back to be most useful.
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    I wouldn't call them "Live Victims" as much as I would call them "Probies."

    When I was first new, I found that I learned a fair bit from being inside the vehicle while the others extricated it from around me. If gave me a good idea of what was going on, from the inside and later from the outside because I could visualize what we where doing, and why (because I was once in the inside). I also learned what works better for PT access because I too was once hauled out of a vehicle. (bigger the hole, the better).

    I am not saying to strap in the probie and roll him off a cliff in a vehicle. I am just saying, sometimes the best way to teach is to put them in the situation of the PT... then they REALLY understand what it is we do, and why.

    Anyway, just something to think about.
    "No one ever called the Fire Department for doing something smart..."

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    As with many things, exercising good judgement and discretion is key.

    How many times do we go out with the tools just to play around? How many times do we actually have a couple dummies in the car -- if for no other reason than limit our ability to "cheat" and use tools where we wouldn't 99% of the time in real life. Empty cars to learn the basic skills, dummies to make practicing more interesting.

    Certainly real victims are relatively easy to find, and can give a lot of feed back. Great if your practicing patient care, not just cutting cars, live victims may be an appropriate trade-off in risk v. benefit.

    Don't forget the "risk" part of it. Live victims, with eye and other appropriate protection, sitting in a car on four wheels that you have to pop the door and remove the roof is one thing. Placing live victims in a car that's on it's side and is going to need true stabilization with struts or winches just to make it safe isn't a place live victims should be in -- due to the added risk.

    And don't neglect the benefit part of risk v. benefit either. Sure, the car is sitting on all four wheels and all we'll do is pop the doors and remove the roof. If we're not practicing EMS skills, why bother putting a live victim inside even if the risk is low?

    Matt

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    I think you pretty much just summed it up Dal.
    "No one ever called the Fire Department for doing something smart..."

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    sitting in a car on four wheels that you have to pop the door and remove the roof is one thing. Placing live victims in a car that's on it's side and is going to need true stabilization with struts or winches just to make it safe isn't a place live victims should be in
    I don't know what your competitions are like for scenarios, but ours are getting quite hard and technical and the use of live victims is becoming more and more common....

    Why do we justify live victims for comps but not always for training? (In comps, we have added pressure of time limits, etc, so the likelihood of making a mistake is higher when compared to training at a controlled pace and controlled environment...)
    Luke

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    we only use live victims when the drill is training on packaging patients but not conducting any cutting. some months ago we trained on putting c-collars on live patients and moving them onto backboards. it was good training and the firefighters learned some lessons that will stick with them for a long time.
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  13. #13
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    Originally posted by lutan1
    we have added pressure of time limits

    Get the probie into the vehicle... knock the door handles off the doors.... take a jerry can (filled with water) start pouring it all over the car... they yell at him/her through the window "This is going to be a timed scenario... we hope to get you out in time...."

    "No one ever called the Fire Department for doing something smart..."

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