Road Traffic Instructor Course

The Road Traffic Collision Instructor Course is aimed at Fire service personnel who are about to take up a position or who are responsible for the delivery of road traffic collision training and development, at all levels within the fire service.

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Dispelling RTC myths with CPD

Earlier this month our Head of Curriculum, Ian Dunbar, delivered a successful two-day continuous professional development (CPD) event to instructors, operational staff, extrication team members and supervisory officers from Lincolnshire Fire and Rescue Service. The course also gained valuable expertise from Dr David Cookson, Associate Lecturer in Paramedic Science, who provided input during the discussions on current approaches and methodology of patient extrication.

Ian reports on how the CPD event took shape.

 

We started by assessing our own skills, knowledge and understanding of the subject and discussed how we can (as individuals and as an organisation) advance the subject to increase better patient outcomes at the roadside. At the heart of this discussion was multi-agency training and the need to do more at all levels. We then discussed the amount of information, disinformation and misinformation available on line which has created many grey areas for instructors and operational staff alike. This is principally due to the fact that many elements of vehicle extrication are open to opinion and interpretation. I was able to demonstrate clear examples of misleading information which has led to confusion and actually, in some instances, informed our training and operational approach.

The group were updated on the latest vehicles design, construction methods and passive safety systems and discussed the data relating to undeployed airbags and high voltage systems found in hybrid and electric vehicles. They are currently two of the most discussed issues, with the risks from these systems often taken well out of context.

In relation to the Fire and Rescue Service Team Approach, I presented an updated version which now considers our greater understanding of modern vehicles and the patient. I feel the current 6 phase approach is no longer fit for purpose and the next generation of fire fighters are in danger of approaching vehicle extrication the way I did, more than 25 years ago. This led to fantastic discussion on the merits of changing a doctrine that we have used for nearly three decades. The Team Approach v2.0 reflects modern vehicle systems (e.g. includes a shutdown procedure for electric vehicles) and critically promotes considering the process of vehicle relocation to increase safety, improve patient access/egress and ultimately reduce scene time. The rationale for change is based on having a more comprehensive reference for vehicle extrication and definitely serves as a more robust model for training the next generation of operational commanders.

We then looked at extrication planning and all agreed that there is a lack of teaching in this area with incident commanders mostly developing their own skills organically. Using timelines and examples of space creation I was able to offer an alternative to A and B plans by asking them to consider Urgent, Immediate and Rapid Plans which are less didactic and more considerate of the medical needs of the patient. In reality, this alternative approach differs very little from our current methodology, but we all agreed it allows the incident commander to plan more flexibly and be able to react to a dynamic change in the patient’s condition.

From a practical perspective, we initially went back to basics looking at hydraulic rescue equipment and how to use it more effectively and efficiently. We looked at the subject of cutting hinges. This is without doubt the largest contributor to hydraulic cutter damage and demonstrated the most appropriate method which is far safer and greatly reduces the risk of damage and as a result reduces cost to the organisation.

We then looked at application of The Team Approach v2.0 and applied the principles of appropriate glass management, space creation and full access i.e. performing these tasks with more patient consideration. With the help of Dr David Cookson, we discussed medical issues such as trauma induced coagulopathy and how this massively impacts our perceived time on scene and the need to keep your patient warm when they have sustained certain mechanisms of injury. Of course, we also discussed spinal trauma and our current practice of immediately stabilizing a vehicle (and patient) in situ to prevent any movement. We discussed the evidence and data surrounding spinal trauma and related this to our long-standing approach. This led to the subject of vehicle relocation i.e. moving the vehicle to a more optimal position before beginning the technical phase of the rescue. This is not routinely practiced in the UK but extensively so in other areas of the world where I have seen it used to great effect (e.g. Australia). It can, if performed correctly and appropriately, reduce scene times and lead to better patient outcomes. Some were naturally a little skeptical as this is a considerable departure from our current approach. However, after discussing medical advantages and proving the concept by practicing several scenarios, we all agreed that maybe vehicle relocation is something we should consider as a matter of routine.

Over the two days of the event we looked at how we have historically approached vehicle extrication and carefully considered if the way we currently do it is as patient centred as it could be. We identified ways of improving our training, approach and methodology and also dispelled quite few myths along the way. Thanks to the folks at Lincolnshire Fire and Rescue Service and to Dr David Cookson for his invaluable medical input.

If you would like to discuss Continuous Professional Development for Road Traffic Collision, feel free to contact me on idunbar@fireservicecollege.ac.uk

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