Mountain Rescue Council First Aid (Casualty Care) Syllabus

It is intended that this syllabus will provide a level of skill very relevant to mountain rescue in the British hills. There is an expectation that this level will be obtained by most team members.

The core of the syllabus is in many respects similar to the first aid teaching of other courses. It does however differ in some very important aspects. A much greater knowledge of topics such as hypothermia will be expected. Greater skills in actively managing fractures should be attained and, of course, familiarity with the drugs approved for mountain rescue is necessary.

This syllabus does not however encompass more advanced techniques, such as IV Infusion , which is to be dealt with as a separate issue.

Great emphasis is to be placed on the practical aspects and skills. This will be reflected in the examinations. Failure to perform adequately in the practical part of the examination will almost always lead to failure

Although the syllabus may be proscribed in some detail the depth to which a topic is studied is more difficult to define and some variation according to aptitude and interest will develop.

Of the practical Skills that of diagnosis is undoubtedly the most difficult to acquire particularly in respect of medical conditions

The examination will recognise the conditions and problems most frequently encountered. It should, for example be noted that approximately 70% of all injuries involve the ankle or lower leg. A high level of competence in the application of splints in this area should therefore be attained

The teaching syllabus will take different forms e.g. intensive weekend courses, regular weekly sessions and there is no particular preferred model. The examination however will take a more standard form. This will consist of a written paper (usually the MCQ type) followed by a practical
examination which will be largely directed by "external" doctors.

GENERAL TREATMENT

Awareness of safety of and risks to team members. Recognise priority of ensuring safety before instituting treatment of casualty.

• Ensure safety of casualty and protect from further injury.
• Control haemorrhage.
• Dress wounds.
• Apply bandages to limbs and head.
• Administer IM injections.
• Patient reassurance and "bedside manner".
• Record observations and treatment
• Communication of medical information

Resuscitation

• airway control
• proficiency in CPR
• assess effectiveness

Detailed anatomical knowledge is not necessary

Where anatomical features do need to be learnt it is preferable that the correct "medical" term be known, e.g. femur in preference to thigh bone.

A working knowledge of the following should be gained.

1. Surface anatomy of

Major vessels

Major bony points

Structure such as trachea, Heart, etc.

2. Respiratory tract

Particularly upper airway

3. Skeletal system

Long bones of limbs including Main points

Spine and spinal cord

4. Anatomical sites suitable for IM injection

PRACTICAL ASPECTS

Able to demonstrate 1 and 4 above.

• Good knowledge of the mechanics of breathing and the process of respiration.
• Principles of blood circulation and heart action.
• Temperature control - modes of heat loss and gain
• Principle features of blood sugar control.
• Main factors of blood clotting and arrest of bleeding
• Principle features of sugar control

• General effects of injury
• Good knowledge of shock - causes, symptoms and signs.

Major hazards of infection

• to the casualty
• to the rescuers.

Understand the accompanying soft tissue injuries and risk of damage to nerves and blood vessels.

Know :

• the signs indicating a fracture
• the difference between stable and unstable fractures
• the definition and risks of a compound fracture
• expected blood loss and various factors.

Have a picture of likely fractures according to age and nature of injury. Be particularly aware of injury grouping e.g. spinal injury with fracture of calcaneum.

Recognise and know particular risk of these injuries

• Wrist and forearm fractures
• Elbow fractures and dislocations
• Fracutres of humerus
• Shoulder dislocation
• Clavicle fracture
• Ankle fracture
• Tibia and fib fractures
• Patella fractures
• Knee ligament injuries
• Femoral shaft fractures
• Femoral neck fractures

PRACTICAL ASPECTS

Assessment of distal circulation

Splintage and where necessary reduction (Importance of traction)

Apply

• Collar and cuff
• Broad sling
• Kramer wire splints
• Inflatable splints
• Vacuum splints
• Lower limb traction splints

• Mechanism of injury
• Risks at different spinal levels
• Indications of cord damage or risk of damage

PRACTICAL ASPECTS

Ability to

• Apply cervical splint in any position
• Immobilise spine using spinal split or vacuum mattress
• Move patient safely
• Protect pressure areas

• Be familiar with the concept of a "working diagnosis".
• Have a clear picture of probable injury patterns.
• Be able to compare right with left, and patient and self

PRACTICAL ASPECTS

Be competent to

• Perform systematic examination
• Record pulse rate at different sites - recognise irregular pulse
• Record respiratory rate
• Recognise cyanosis, pallor, skin temperature, sweating
• Assess blood loss from clothing etc.
• Communicate findings by radio

Recognise serious problems

• Unstable fractures
• Pneumothorax
• Intra-thoracic bleeding

PRACTICAL ASPECTS

• Stabilise flail segment
• Seal Penetrating wounds

• Heat stress
• Heat exhaustion
• Dehydration
• Treatment
• Rehydration
• Cooling
• Dangers of heat stroke

• Mechanisms of heat loss
• Mechanisms of heat gain
• Cold defence activity
• Cold stress
• Hypothermia
• Risk situations . symptoms + signs hypothermia
• Importance of exhaustion and hypoglycaemia

• Insulation
• Air warming
• Profound hypothermia
• Monitoring during evacuation

PRACTICAL ASPECTS

• Temperature measurement
• Oral & rectal
• Tympanic membrane
• Cas bag insulation
• Use of air warming device, e.g. Little Dragon

• Symptoms and signs
• Treatment

• Assessment of blood loss
• Risk of deep structure damage
• Clean - Vs - dirty wounds
• Possibility of handling foreign bodies

PRACTICAL ASPECTS

• Arrest of bleeding
• Application of appropriate dressings

• Assessment of % area
• Appropriate dressings

• Awareness of risk groups
• Bandaging to limit effects

• Relation with hypothermia
• Inhalation
• Aftercare

PRACTICAL ASPECTS

• Clearing airway
• C P R

• Recognise risks
• Diagnose cardiac problems and burns

PRACTICAL ASPECTS

• CPR
• Treat burns

• Risk of "crush syndrome"
• Local effects of crush injury
• Abdominal injury
• Recognise potential serious nature of injury
• Regular monitoring of vital signs

PELVIS

• Symptoms + signs of pelvic fracture
• Risk of serious blood loss
• Risk of injury to abdominal and pelvic organs

FACIAL INJURY

• Recognise probable fractures mandible and facial bones
• Risk to airway
• Possibility of serious haemorrhage
• Risk of associated injury
• Missing teeth - significance and Preservation

PRACTICAL ASPECTS

• Maintain airway
• Control haemorrhage
• Care of teeth

• Knowledge e of the drugs currently on the MRC list of Kit 1 and Kit 2
• To include mode of action indications, contra-indications, possible side effects
• Knowledge of legal aspects of D D A's

PRACTICAL ASPECTS

• Procedure for checking drugs
• Administration of drugs by various routes

• Blunt -Vs- penetrating injury
• Primary and secondary brain injury
• Conscious level
• Post traumatic amnesia
• Compound skull fractures - cerebral oedema intra - cranial bleeding
• Critical nature of airway and ventilation
• Important signs, e.g. bleeding from ear
• Risk of cervical spine injury

PRACTICAL ASPECTS

• Control of airway
• Arrest of scalp bleeding
• Completion of Glasgow Coma Scale

• Snow blindness
• Foreign bodies
• Corneal injury

PRACTICAL ASPECTS

• Removal foreign bodies
• Irrigation
• Installation of drops/ointment

The diagnosis of medical problems will often be exceedingly difficult even in the major conditions. (Few if any intensive care units have not treated indigestion as myocardial infarction for 24 hours).

Recognition of the typical presentation of common Major problems only is expected but the variability of the clinical picture should be understood.

MYOCARDIAL INFARCTION

• Symptoms and signs
• Relation to angina
• Risks of arrhythmia etc.
• Treatment

ASHTMA

• Nature of disease
• Precipitating factors
• Treatment

HYPOGLYCAEMIA COMA

• Causes
• Recognition
• Treatment

EPILEPSY

• Symptoms and signs
• Treatment

ACUTE TOXIC ILLNESS

• Likely diagnosis
• Management

ACUTE GASTRO-ENTERITIS

• Risk in small children
• Treatment

MIGRAINE

• Typical symptoms

OTHER COMMON MEDICAL PROBLEMS

A broad appreciation of these is useful but the examination will not focus on these.

CARE OF FRIENDS AND RELATIVES

• Psychological aspects of injury
• Bereavement

DEATH

• Awareness of legal aspects
• Some knowledge of death in suspicious circumstances.