Exploiting the synergies between Mariner and Fire Fighter with bespoke Immediate Medical Care training

It has long been known that ‘Saving Lives at Sea’ is the primary purpose of the UK’s Royal National Lifeboat Institution (RNLI), working in collaboration with the UK Maritime Coastguard Agency (MCA). One of the tools in its arsenal to achieve this is the unique, ground-breaking and award-winning pre-hospital medical training package – RNLI Casualty Care, colloquially known as ‘Big Sick – Little Sick’.

The RNLI Casualty Care qualification is recognised at Level 3 of the UK Search and Rescue (SAR) Operators Medical Group Framework, with medical skills equivalent to an Emergency Medical Technician.

The RNLI course has received the following approvals:

The College of Paramedics
The Paramedic Science Degree course at the University of Hertfordshire
The Anaesthetic Trauma and Critical Care (ATACC) group
The Royal College of Surgeons (Edinburgh)

The creator, Paul Savage – ‘RNLI Clinical Operations Manager’ has just been awarded an OBE in this year’s ‘New Year’s Honours List’, in recognition of his services in designing this whole approach that has revolutionised UK Maritime Safety.

When your organisation is made up of around 95% mixed ability volunteers, drawn from all walks of life, training is vital, but the time to train volunteers can be extremely limited. It is this challenge that the RNLI is blessed with every day. In this new century, it is not broadly known, that less than 1 in 10 of the organisation’s volunteer Lifeboat crew come from a professional maritime background. Excepting the Coxswain and the Mechanic, all the crew have regular day jobs, responding to incidents on demand via a pager system. One aspect that makes the RNLI Casualty Care course so unique is the ability to take their lifesaving volunteers, very often with little or no prior experience in medical training, to a level of functionality comparable with that of an NHS ambulance technician. The surprise is this is reached in just three days!

How has the charity achieved this? Well, knowing that time is a critical factor, both during training and during lifesaving, and recognising, importantly, that most of their volunteer crew are kinaesthetic learners, the RNLI has developed a training course that removes the complex anatomy and physiology normally associated with medical training, and strips it back to what is essential to keeping the casualty alive until they are handed across to the medical professionals.

Centred around a detailed patient assessment and a set of protocols, all mapped out on waterproof Check Cards, the need for long term memory is removed, therefore reducing skill fade levels. This is backed up with the blended resources of the Course Manual and Medical Scenario Cards, which all interlink with the individual’s Check Cards. It is recognised that this is the only course in Europe to have this total blended approach of fully interlinked resources spanning treatment to training.

The beauty of this training is its simplicity. More often than not, medical courses are heavy with theory that is not always directly beneficial to the casualty and can be confusing for the student. With the RNLI training course, the theory is kept to a minimum and so the student learns by doing, working their way through hands-on training and cleverly constructed scenarios to re-affirm learning. This style frees up course time to allow confident kinaesthetic skills to be gained in high level medical equipment. The RNLI has been delivering its pre-hospital casualty care training course ‘Big Sick-Little Sick’ to its volunteer Lifeboat crews and Lifeguards for the last five years with stunning results.

Acknowledging the significant contribution this training has provided the RNLI in saving lives – and they have the statistics to back this up – and recognising the ability of this training package to crossover to other lifesaving organisations, the RNLI has decided to open up its doors, giving other organisations the opportunity to hire the services of the RNLI to develop their own bespoke Casualty Care training package.

In drawing a comparison with the Fire and Rescue Services, we recognise that for the Firefighter, fire-fighting is the first priority; for our volunteer Lifeboat crews, Search and Rescue is their primary role. However, both Firefighters and Lifeboat crews must then move seamlessly into immediate medical care of the casualties, once the initial element of danger has been mitigated against (whether that be a fire, the roadside or the sea). The aim being to stabilise the casualty until such time that the medical professionals arrive on scene, thus increasing their chances of survival.

Casualty Care is a vitally important role of the Fire and Rescue Service, protecting a casualty’s injuries and improving their chain of survival, allowing the Firefighter to save saveable life. For the Firefighter, once they have utilised their skills and resources to rescue the casualties, they now have to keep them alive; this can be very often conducted in a difficult and dynamic environment. Although Firefighters work closely with the Ambulance Service and aim to hand over the casualties to the medical professionals, the role of the Firefighter is to assist and care for the casualties until such help arrives.

The first Fire and Rescue Service organisation to grasp this opportunity has been Dorset Fire & Rescue Service (DFRS). This development was born out of the strong collaboration between DFRS and RNLI. Recognising the strong correlations between the two different types of lifesaving organisations, the RNLI and DFRS have worked together to convert the ‘RNLI Casualty Care’ into ‘DFRS Casualty Care’, a pre-hospital medical training package bespoke for the Fire and Rescue Services.

Although Casualty Care is a specialised field within the Fire and Rescue Service, this unique and bespoke training prepares the Firefighter to manage the situations that are encountered in hostile working environments during operational incidents. Dave Myers, DFRS Head of Training and Development said:

“The check card system and scenario cards enabled the delivery of a very practical course and continuation training. This is the hands-on training our Firefighters require and can be delivered in a style that suits a range of learning styles – a great balance of practical to theory.”

The training and equipment have been designed using the Information Recording System (IRS) data about incident types and casualty injuries. Rich Cole, DFRS Station Training Manager said:

“The mapping of the course to ‘Redkite’ (electronic training records) means through continuation training, whole time duty Firefighters will no longer need to go on a 3 day refresher course saving time, money and improving staffing levels (over 200 shifts a year in Dorset). Retained duty system staff may still need a 3 yearly refresher, but this has been reduced from 3 days to 1 day. Once again this saves time, money, and improves fire cover by leaving staff available”.

The training course focuses on effective hands-on treatment rather than complex theory or diagnosis. The aim of this training is to simplify the subject matter, in order to allow the Firefighter to safely focus on their core skills, such as Breathing Apparatus and Working at Height. Firefighter, John Powell said:

“From a service point of view, Firefighters have more competencies than ever to remain safe; introducing a system of casualty care that reduces the expectations on the Firefighters skills capacity is very positive. We can deliver a higher level of casualty care while letting the Firefighter concentrate on safety critical aspects of their job like breathing apparatus. This makes a safer Firefighter.”

However, when called upon to care for a rescued casualty, which is an increasingly vital element to the Firefighters portfolio of skills; by using the treatment check cards, which are ‘fit for purpose’; the Firefighter is empowered to confidently treat casualties to a high standard, both safely and effectively every time.

The same is true for Lifeboat crews when treating casualties on a ‘shout’; often carried out in demanding and stressful situations – on the deck of a Lifeboat in a Force 9 gale, or in a flooded home as part of the charity’s Flood Rescue Team. Like our Firefighter colleagues, our volunteer Lifeboat crews benefit from a simplified, logical approach to casualty care.