Does your lake have protocols for trauma situations?

[cragginshred]

Sitting around the dock yesterday I brought up the topic of having some annual training to discuss how to handle a head or spinal cord injury as well as having a snake bite kit on hand (two rattle snakes killed on site since early sept -one in the boat house). I proposed having a back board on site as well as updating the 1st aid kit each spring. In addition I suggested some sort of training for scenarios such as; aiding an unconscious skier in the water.

For this thread I am asking for resources for this sort of scenario as well as get a feel for what type of training or plan your private lake or club on public water has?

Thanks in advance!

Don

[ral]

We do have them, but we should practice them regularly and we do not....

[Stevie Boy]

All boat drivers at our club have to have first aid course, one of the most important things for the boat and clubhouse is emergency numbers and postal address as well as gps location, for emergency services, ideally someone in the boat should have some form of communication.

Never assume, it will never happen, somewhere at sometime it may, no matter how safe we operate, the unexpected may catch you off guard maybe another boat with with sub standard operator, be aware at all times.

Stay safe, Ski long

[Edbrazil]

Good thought. We ran regular 3-event tournaments in NH in the late 1970's, at a site that was a bit out in the boondocks. One tournament, in jumping, a guy took a fall that didn't look all that bad, but he ripped up his face badly. We really weren't prepared for that, or for other serious injuries. Got him to the hospital, and he did recover, but it turned out to be very close to being a serious injury per the doctors. After that, we always were sure to have an EMT and gear present at all our events. Still, for practice skiing, we really weren't ever prepared, and many times we practiced with just driver and skier.

[lakeaustinskier]

I'm honestly not sure exactly what AWSA requires but a great class is the American Red Cross Wilderness First Aid Class. This class is based on the Wilderness First Aid protocols of the Boy Scouts of America. This class teaches participants the "assessment of and treatment given to an ill or injured person in a remote environment where definitive care by a physician and/or rapid transport is not readily available"....in other words a lot of water ski sites. As a Scout leader I've taken this class and I highly recommend it.

[bishop8950]

We have a back board, first aid kit and AED. Some of us are trained to some extent. Easiest things to be lazy about are 1) keeping up with training 2) making sure there is a spotter and others around if something should happen.

[Horton]

Wife got concussion & possible broken ankle at tennis club today. The club staff was like deer in the headlights.

[gregy]

We don't and its bothered me.

[cragginshred]

Exactly what I am talking about Horton. Pro active not re active is my mo. No one wants to ever encounter a trauma scene. Basic stuff to know just in case:

 

-Stabilize C spine, this is the tricky one for a water to boat then to dock scenario. I will research and post what I find. Others who have protocols or paramedics please chime in on this.

 

-Pressure on lacerations or bleeding parts. Head wounds bleed profusely but are often not as big of a deal as they may seem. More on a recent incident at our lake later.

 

-Splint broken limbs with make shift stuff if needed able.

 

-Head injuries, is there csf (clear fluid) flowing from ears or other cranial orifices? Are the pupils equal round and reactive to light? Are they oriented to place, person and day? Give them 3 things to remember and ask them to repeat it back over an hour period to monitor a change in cognition. If concerned obviously do not let them drive. Remember Liam Neeson's wife bonked her head. They thought she was ok and then passed the next day.

 

[ral]

@Horton, as @cragginshred raised the topic we might collectively try to get/do some kind if protocol and have it accesible from the BOS front page, obviously with the appropriate disclaimers?

[ral]

Starting point...

 

http://www.iwsf.com/SafetyManual/IWWF%20Safety%20Manual.doc

[ral]

@Horton, how is your wife doing?

[John Brooks]

I think that 2 of the best things you can do is have a AWSA Safety director come to your site and hold a safety clinic for your members, the second is to have several take the Red Cross CPR & First Aid class. The AWSA safety clinic does a nice job of covering safety techniques specific to our sport, such as how to properly turn over someone laying face down in the water. The CPR & First Aid pretty well covers everything else. All of this knowledge is good to have, you never know when you will be put in a situation you will need it.

[skidawg]

@horton...she needs to start jumping, that tennis is dangerous!

[kona]

First of all hope your wife is doing better and recovering,

second combat tennis is rough,

third I am an EMT in Utah and spend a good part of my winter and summer practicing it. Yes practice is what we all do and practice makes perfect. What ever you can do to train and prepare yourself for an emergency situation is a plus. You never know when you will need it. Keep a good first aid kit handy and if you know what your doing get yourself a trauma kit. "BE PREPARED" !!!!

The person you help or save may be a loved one or close friend.

Have a good winter and ski FAST where ever it may be.

[Horton]

Gallagher aka Muffin is going to be fine. She broke the very bottom of her fibula. she is more upset that she didn't win her tennis match.

[ToddA]

@John Brooks, the idea of "turning someone over who is unconscious in the water" is no joke. I heard of one particular incident in a public river where a multitude of things happened. One, the skier took a hard OTF fall, knocked unconscious, the driver (only one person in the boat with his drysuit on but unzipped) responded quick, didn't want to jump into the water with his open drysuit, so leaned over and did roll him over and pulled him onto the platform. Obviously could have been a life-altering problem as the skier did have a non-displaced C/S fracture, severe concussion. Anyway, skier was ultimately fine, but did bring up more than a few issues that we should all keep in mind, especially the driver-only scenario in a larger public water forum.

[LeonL]

Time to relate the story of a friend of mine. Guy was tricking on a private site with wife driving. Very experienced couple, she drove and pinned for him by herself. Doing toes, caught an edge, she released him but thing like that happen so fast. She came back to pick him up, turns out he fractured his pelvis. They managed to get him on the platform, and started idling to the dock. He passes out and tumbles into the water, she gets back to him and get in the water to support him. Here's where the big mistake happened, as neither has flotation on. Boat floats away and both nearly drown. It's a two lake site and she screams and screams finally while slaloming in the adjacent lake the boat stops at the end and they hear her. Closes call. Back to the thread. EVERY site needs to have an AWSA qualified safety coordinator at least and better yet a state safety director. They then need to give everyone, at a minimum, training on righting an unconscious skier. This may be the most important thing to know. Avoiding drowning while not exacerbating a potential spinal injury. Oh get yourself a backboard too.

[mwetskier]

we always have at least 1 cell phone in the boat and keep an industrial first aid kit at the dock. i am emt certified and my brothers wife is an md with additional outdoor search and rescue training. even so if something really bad happened thats prolly not enuff.

[Skoot1123]

@cragginshred - great thread to raise awareness buddy!

[A_B]

Is there a video of turning someone over in the water? I know how to do it on land from training, so assume it should be similar, but I have never seen this done.

 

One of the local lakes had a rookie skier fall and smack his cheek hard on the ski and knocked himself out, face down. So it does happen.

[cragginshred]

Thanks to all for chiming in and the testimonials @ToddA and @LeonL whew! Here is a link to a lifeguard training pdf. First part of Pdf is kinda straight forward, but going down to the below section does give some good info for an unconscious skier rescue. Hint (link has pictures in pdf) This technique makes sense and in line with the statement from the IWWF doc @Ral shared regarding not using the swim deck as a rescue platform unless you have to.

 

http://trimbath.weebly.com/uploads/1/0/6/1/10617050/chapter5.pdf

 

Passive Drowning Victim Rear Rescue

Use the passive drowning victim rear rescue when the victim is at or near the surface, seems unconscious and a head, neck or back injury is not suspected. (If a head, neck or back injury is suspected, use the techniques de- scribed in Chapter 10.) A passive drowning victim may be floating face-down at or near the surface in a vertical-to- horizontal position. The goal is to put the rescue tube un- der the victim’s shoulders or back to support him or her face-up. To perform a passive drowning victim rear res- cue, the lifeguard should—

1. Approach the victim from behind (Fig. 5-18, A). 2. Reach under the victim’s armpits and grasp the shoul-

ders firmly (Fig. 5-18, B). The lifeguard may be high on

the victim’s back when doing this. 3. Squeeze the rescue tube between the lifeguard’s

chest and the victim’s back. 4. Keep his or her head to one side to avoid being hit by

the victim’s head if it moves backward. 5. Roll the victim over by dipping the lifeguard’s shoulder

and rolling onto the back so that the victim is face-up

on top of the rescue tube (Fig. 5-18, C). 6. Tow the victim to safety (Fig. 5-18, D). For greater

distances, use one hand to stroke. Reach the right arm over the victim’s right shoulder and grasp the rescue tube. Then use the left hand to stroke. Or reach with the left arm and stroke with the right hand.

RESCUING A SUBMERGED VICTIM

Sometimes a drowning victim is below the surface. This could be in shallow water or in deep water beyond the lifeguard’s reach. This may occur when nonswimmers or very weak swimmers enter water over their head. A vic- tim may also submerge after a cardiac arrest, stroke, seizure or other medical emergency resulting in uncon- sciousness in the water.

Passive Submerged Victim—Shallow Water

To rescue a submerged passive victim in shallow water, the lifeguard should— 1. Swim or quickly walk to the point near the victim’s

side. Let go of the rescue tube but keep the strap

around the shoulders. 2. Face in the same direction as the victim, submerge

and reach down to grab the victim under the armpits

(Fig. 5-19, A).

3. Simultaneously, pick the victim up, move forward and roll the victim face-up upon surfacing (Fig. 5-19, B).

4. Grab the rescue tube and position it under the victim’s shoulders (Fig. 5-19, C).

B

C

D

Rescue Skills

67

Fig. 5-19

A

B

C

D

E

5. Move the victim’s arm that is closest to the lifeguard down to the side of the victim. Reach the right arm over the victim’s right shoulder and grasp the rescue tube or reach with the left arm over the victim’s left shoulder and grasp the rescue tube (Fig. 5-19, D).

6. Move the victim quickly to safety (Fig. 5-19, E).

Active or Passive Submerged Victim— Deep Water Feet-First Surface Dive

 

So,... this would require keeping a rescue tube on the boat. To me a cervical support and mid trunk one would be optimal. At most lakes like ours they are 5' deep and you could walk a floating patient to the shore where they could be met with a back board, bag mask ect. while ems would be on the way.

 

Don

[GOODESkier]

@ToddA I think I might be the driver in the event you described above on the Columbia River back in September 2012. Details got change a few times in the "telephone game", but basics are true.

 

I was skiing with a friend (17 years old), and he took an odd (out the back fall I believe) and I knew it was an odd/bad fall by the release and the "sound" if that makes any sense. Turned the boat fast, and he was basically missing. Eagle vest + No Air in Lungs = Almost Submerged victim pretty fast.

 

I was NOT in a dry suit. I was in my street cloths. I was the only one in the boat. I jumped in, rolled him onto his back. Began a few rescue breaths on the way to swimming him to the swim platform. Slid him onto the platform. Still not breathing, gave 2 more breaths. Still not breathing. Just beginning CPR and he coughed up some river water and blood and began wheezing.

 

Called 911 from the phone in the boat. Got the call in and the emergency and the location, but then the operating system on the droid froze up and I could not make another call. REMOVED HIS SKI (yeah it didn't come off in the fall, which is why I think it was an out the back). Tied his arm to the lift hook with the ski rope. Kept monitoring his breathing and pulse as I pointed the boat towards our ramp and had it in gear at an idle. (1/2 mile from our course to the ramp). Running back and forth to steer and monitor his breathing.

 

I arrived at the dock about 30 seconds after the first EMT. My buddy never regained consciousness until after he arrived at Harbor View in Seattle. That was an ambulance ride to Wenatchee, a JET PLANE AIRLIFT to Seattle, and another small ambulance ride. He suffered a skull fracture, a little loss of hearing, and a year long recovery plan.

 

NOT A GOOD DAY! Best ending though, as he has done a lot of skiing with me this past summer. During the accident, I did not see a good ending anywhere ahead of us. Doctors said that if you had to get a brain injury, this one happened in the best possible spot. There were no signs of the ski hitting him, just the impact of the water. A year later he is almost back to his normal self and started college this year.

 

As a small amount of background. I ran a waterfront for a large children's camp in Northern New York for 10 years (5 inboard ski boats, sailing program, waterfront and pool swim lessons, etc...), I am WSI, Professional Lifeguard Certified, and had JUST THE DAY BEFORE THIS ACCIDENT RE-CERTIFIED MY CPR! So, I had plans in place in the case of an emergency. I didn't have a backboard, but the swim step worked as best as it could on public water. I was all alone and could have used another person to drive as I monitored my buddy's breathing, and it sure would have been nice to get the 911 call off as it happened rather than 4-5 minutes into it after I got him breathing! Although the response time to the dock would have been about the same.........

 

Things we have changed:

1. Everyone in the boat is ready to enter the water. I got lucky that day, cause I usually have my dry suit or wet suit 1/2 on and 1/2 off. WE NOW ALWAYS WHERE A ZIPPED wet or dry suit in the boat so we can be as fast as I was that day about helping the victim. This was sheer luck that day...........

 

2. We try very hard to NEVER be in the boat without a 3rd person or atleast another boat on the course with us. BUT, that doesn't always work like it should since we are often a husband/wife and my children team when we ski.

 

3. I carry scissors (to cut vests, gloves, boots, dry suits OFF), an air horn to signal others of an emergency, and I have talked to our local emergency responders about where we would dock in the event of another emergency. I also have a dedicated "cheap/cancelled" cell phone in the boat that remains on the charger and ON all the time. I know it works from our site and it is not password protected and anyone can operate it and everyone knows where it is in my boat.

 

THINGS I SUGGEST:

1. Just like back country snowmobiling/skiing ...... it is the people you are with that will either save your life or watch you die. You choose how prepared you want the people on your lake to be and what tools they have to help you when you are laying face down in the water with a head injury.............. I personally want my buddy I snowmobile with to have the BEST possible avalanche gear and be trained to use it. No training=I DON'T RIDE WITH YOU!

 

2. Private Site should have contacted their local EMS and have a plan in place for getting to your site. Should also have EVERYONE who is a member/driver trained and ready to respond for an emergency.

[ToddA]

@GOODESkier, sorry for the errors in the details! :) Yeah, it has been awhile since I have chatted with your buddy over on Planet Nautique (I am really glad that he is doing well!). Your points made up above are really worth taking note of...thanks for writing in and clarifying the situation and some of the things that all of us could take to heart.

 

[ToddA]

Oh, and @GOODESkier, your buddy was one lucky skier to have had you in the boat too...

 

[GOODESkier]

@ToddA I was the lucky one as well. It reminded me of the potential danger associated with this great sport! I think I was well prepared to handle the situation, but I am very aware that the people in the boat while I am going for that 38' off pass have the responsibility to save my life should I require that help. I am proactive about making sure my boat crew is ready to respond.

 

[xrated]

Good stuff @GOODESkier.

 

I'm by no means a good skier, but stories like that are why I am not sold on comp vests. Will my CGA vest keep my face up if I get knocked out, maybe maybe not, but it will keep me higher than a NCGA would. I ski public water so I kinda view that the same as I view beacons and probes in the back country. It isn't just for me, it is for the people who will be having to tell others about any incident involving me. As a friend I want to make it as easy for them as possible to have a good story to tell and not a bad one.

 

 

[dave2ball]

@cragginshred the best thing to do is to got to a community college and take a First Responder course. It will show you how to proper C-spine techniques and good first aid skills.

 

[cragginshred]

@dave2ball I have been bi-annually CPR re-certified for the past 15 years and got my EMT in 99, and do wound care periodically as part of the physical therapy discipline that is my profession. I have also sat in on orthopedic surgeries such as total joint replacements. None of this including what you suggested trains you for an in the water rescue of an unconscious skier with a suspected cervical or traumatic brain injury. Hence the discussion here that have prompted great practical ideas that have been brought up that will never be covered in an EMT course due to our sport specific needs. You are right though those courses will teach basic cs precautions that every one should know.

Part of this thread is really to encourage some in service type training for the spring at all clubs as well as raise awareness.

[SusanT]

I ran across this video showing how to use a backboard at your ski lake. Although not a substitute for hands on training, you may want to share it with your ski buddies.

[cragginshred]

@SusanT thank you for sharing this video. Basic first aide or even wilderness EMT courses do not cover specifics like this. You rock!

[boarditup]

I am a former USCG officer and have a lot of water rescue training. I also am a USA Waterski Safety Coordinator. Nothing is a substitute for in-the-water training with a "victim" and a backboard. It is well worth the time and effort. Next season, get the crew together and have a simulated rescue and you will have a much more confident and safer crew. No surfing on the backboard, though....

[SusanT]

When I lived back East and we had a show ski club on a large public water way, it was easy to get the group to agree to annual training with the fire department. I have had very little luck with getting 21 owners on a private lake to do the same :(

 

[cragginshred]

@boarditup thanks for chiming in and please share more as you feel led. @SusanT that is a bummer... I checked out your area in Az,.. looks amazing!

[footloose42]

@boarditup, I agree. If you've only ever practiced backboarding on land, you're going to have quite the time trying it for real in deep water.

[SusanT]

Backboard in the water takes practice for sure, especially when it is deep and has a current.

[boarditup]

We have a volunteer fire department in the area. They train here every summer and winter. We have a first responder across the street - a husband and wife team. Also, there are 3 active volunteer firemen that have to pass the site on every call out. So, we have a lot of visibility with the medical first responders - that really helps.

 

Finally, we are the home site for the GVSU waterski team. I give them a fresh first aid kit every season. Yes, it does cost me personally a few bucks, but I know they have some minimal equipment on the boat. Since I work from home, I end up being the first responder for most incidents - although they are rare - mainly cuts from contact with the skis upon falls.

 

Planning and preparation are key. If you have the right equipment and know how to use it and have trained on it, you can keep calm and take control of the situation. If you are "winging it," the chance of making a bad situation worse goes up exponentially.

[Chef23]

We ski on public water and don't have any procedures and frankly I think we should be better prepared. I keep trying to catch a safety clinic but I wind up in the middle of something else at most events where we have been running them.

[Skoot1123]

@chef23 - you bring up a good point. What do you do if you don't have any training or are not equipped to deal properly with the situation in hand?

 

1. Be calm

2. See above, and call for help

3. Reassure the victim/injured person you are there to help

 

A calm and "in control" demeanor can go a long way to keep the injured person calm and not panic. Can an EMT comment? @kona maybe?

[dave2ball]

I have been an EMT for 20 years an ex paramedic and currently a FF/EMT. As said earlier look calm although you wont be and reassure the patient and first and for most call for help. The biggest issue I have seen is that people want to help but they don't have the proper first aid or lack the experience or training to help. If somebody wants to put a trauma protocol into place into they should really contact there local fire dept and find out what equipment they recommend. Take a first aid or even better a first responder course. Get the proper equipment. Learn how to use it. It it may cost a bit more but you will be ready for when shit happens.

Basic first aid is falls under the good Samaritan act. Where things start to get dicey is when place a person in on a backboard and then place them in C-spine. When you start manipulating a person who has neck pain or back pain and you don't know the correct way to do c-spine and questions to ask before and after placing a person on a board you may be opening your self up to a huge lawsuit. The only time this goes out of the window is if it is a matter of life and death. Where people get into trouble is when they try to do too much and go outside of what they know or were trained on.

[Skoot1123]

@dave2ball - thanks for chiming in. Good points made. I may be contacting the fire dept. by our lake in the future. Our current club has a current firefighter and retired police officer as members - so in that sense we are covered pretty well.

[kona]

@skoot1123 "A calm and "in control" demeanor can go a long way to keep the injured person calm and not panic. Can an EMT comment? @kona maybe?"

 

Absolutely !