First Aid at Work Refresher

British Red Cross

Note for non-UKians; First Aid at Work is the standard certification for British workplace first aiders. The course conforms to a syllabus laid down by the Health and Safety Executive, who oversee the certification and course running. Different organisations in Britain teach the course in different ways but all such certificates should be recognised by employers. The certificate is valid for three years, and may be renewed by a 2-day refresher. It is this refresher course which I took.

My background includes six years teaching First Aid at Work courses, qualification as a NAEMT Pre-Hospital Trauma Life Support instructor, and nine years experience of practical first aid in a variety of situations.

Should anyone from the BRC read this and feel that it is an unfair or inaccurate report, I am quite happy to either add a page with their comments here, or link to one that they provide. Right of reply and all that. Similarly, they are welcome to link to this page. They are not welcome to quote me out of context; I will take an extremely dim view of this.

Venue and Organisation

The joining instructions were clear and unambiguous, with not too much paperwork required to come onto the course. The BRC checked my original FAW-R certification, we had a couple of simple forms to fill in, and that was it.

The teaching room was simple but spacious, with OHP, whiteboard, flipchart, a couple of floor mats for CPR practice plus a variety of Annies and other first aid teaching materials. We had a video on the morning of Day 2; the TV was a bit small but adequate. Tea, coffee and biscuits were provided, and the centre was near a set of shops which made buying lunch easy.

We were each provided with several ambulance dressings, triangulars, safety pins and a pair of gloves. In addition we were given the Revised 7th Edition of the First Aid Manual, which is a pretty good text (though didn't entirely correspond with what was taught).

Overall, this was a good teaching venue and a well-organised course.

Teaching

There were 8 of us in the class, with one instructor. Our backgrounds included the construction industry, teaching, riding instruction, gardening, gym and fitness instruction and telecomms software. One other course member was a first aid instructor (not a current BRC instructor).

Our instructor was a pleasant lady who seemed to have a reasonable amount of practical experience under her belt. Her teaching style was quite relaxed, and she made sure we were not on our backsides for too long at a time.

I learned the following new mnemonics:

Pale: Raise tail
Red: Raise head

for working out what position to place casualties, and:

Left: Lovely
Right: Rotten

for working out which side of the heart carries oxygenated blood.

The instructor was keen to emphasise that she was learning from us as well as vice versa, which was good; she didn't claim to know it all. She had the group working reasonably well together in a relaxed atmosphere, and an appropriately twisted sense of humour.

The one problem was that her background knowledge was significantly deficient in some places. Specifically:

• She clearly didn't know the mechanism by which emotional trauma causes shock -- fair enough, but she tried to explain it anyway which was a mistake.
• She didn't seem to know who defined resuscitation protocols, which really isn't on; any instructor should keep up to date with this.
• She asserted that we could detect spinal injury reliably by feeling someone's back; there was no mention of mechanism of injury as the primary indicator for spinal injury. Emergency Care [1] quotes a 10% incidence of spinal column "steps", so it's clearly not something to rely on.
• She taught manual head immobilisation (as part of the 2-person spinal recovery position) by gripping the patient's jaw. The technique of spread fingers around the ears affords a far better grip on the important part of the head.
• Her grasp of the mechanics and physiology of head injury was clearly shaky. She quoted a flushed face and slow pulse as signs, but did not quote the slow and noisy breathing indicative of serious head injury.

This may give the impression that her teaching was riddled with mistakes -- it wasn't, but the above are significantly wrong and should be corrected. She should be more confident to say "I don't know, but I'll look it up."

Overall, the instruction was done well but background knowledge was a noteable deficiency -- one easily addressed, hopefully.

Course Syllabus

Good resuscitation practice in the UK is defined by the Resuscitation Council (UK). The practice taught on this course differed as follows:

1. No shouting for help after finding no casualty response
2. No explicit checking of the airway during ABC
3. No recheck of B and C after rolling casualty into recovery position
4. Doing a head-to-toe of an unconscious casualty before rolling into recovery position

The instructor also informed me that the assessors would object to my practice of measuring CPR hand position with my left hand and compressing with my right, when on the casualty's right side; I would have to measure with my right and compress with my left. This seems remarkably pointless.

Assessing

The assessments took a total of 2 hours 15 minutes for eight of us, which comes out at about 15 minutes per student (though in practice it was more like 20 as we were pipelined). This is an adequate assessment time. There was the inevitable waiting-around while others went through, but we got to look around the Red Cross museum there so that was interesting.

There was no-one on my course who I thought should not have been passed, so it's hard to evaluate the pass-mark.

Overall, no problems with the assessment; it was well organised and fair.

Summary

Bibliography

Emergency Care -- A Textbook for Paramedics

Eds: Ian Greaves, Tim Hodgetts, Keith Porter
Pub: 1997 W B Saunders Company Ltd
ISBN 0-7020-1975-5

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