List Archives

Sun Apr 22 14:37:22 BST 2007

"Layperson trainings vary greatly in terms of time and content. There is no
generally accepted standard as to what constitutes an appropriate first aid
curriculum other than the recent ILCOR first aid proceedings and the NFGATOS
project. Formal training organizations may grant more structure as
completion of given programs require certain skills to practice (American
Red Cross, AHA, ASHI, NSC, and others)."

Sadly enough, I don't know of any Israeli organization parallel to the AHA, 
ILCOR or ERC, though the EMS here do take part in training of lay persons.
I do agree with what you said- there is no standard curriculum, and there 
are very many diffrent kind of courses. But there ARE guidelines made by the 
AHA who clearly approach the subject of what is the scope of lay persons. 
When these guidelines are overlooked, either in a 4 hour cours or in a 40 
hours course, it's wrong.
I once spoke to my boss about the "training program" and the first aid 
pocketbook they sell to students. One of the things that came up was the Jaw 
Thrust. I explained that it is no longer recommended for lay persons, told 
him the rational and quoted both the AHA guidelines and relevant articles. 
He ask if paramedics are still taought the jaw thrust, and since I said yes 
he decided it'd look better and sell better if we teach that to lay persons. 
When it came to pulse checks, again, merchandizing took over science and 
common sence.

"OPAs are a skill at the 40-hr First Responder curriculum... but should not
be taught at any level under that".

How about a 4 hours course with a curricolum made acoording to customer's 
request, that usually attempts to squeeze in adult CPR, child CPR, infant 
CPR (but without an infant manikin) and first aid?

"I think that simply not teaching it would be counterproductive. A student
who sees that you do not teach them how to insert an OPA may feel
short-changed by you in terms of not learning something he/she might find
valuable/cool/useful/important (or any other adjective). If it is so
widespread and common to teach, if I were you, I would simply dedicate less
than 1 minute to say why anybody who is not  a healthcare provider should
NOT insert an OPA without further knowledge on airway anatomy, proper sizing
and proper practice time if the current training program does not allow for
all of them."

Actually, that's exactly what I do.
Having that said- I want to state that the new AHA guidelines for lay 
persons are amazingly easy to teach and learn. While other instrucotrs spend 
their time teaching more complicated algorithms with diffrent decision 
making station, my students practice on the manikin.

I once had a class who were taought by another instructor, who literally 
abused them, and I had about three hours to teach them and test them (it was 
a 22 hours course they had). The first thing they said was that CPR is so 
complicated to learn and remember, and that they didn't know when they 
should give breaths, when compressions, it was hard to remember how to find 
comressions landmarks, etc. (Not to mention the amount of material he made 
write, reading it out of the notebook, about HY, asthma, and on and on...)

It took me 10(!) minutes to teach them proper CPR according to new AHA 
guidelines. 10 minutes, and I'm talking about 14-15 year old kids.

"Just my $0.015's worth of opinion."
Sorry, out of change. Do you accept travellr's check?

>From: "Gustavo E. Flores" <gflores911 at gmail.com>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
>Subject: RE: OPA, lay persons,and regulation of training in Israel and 
>world wide
>Date: Sat, 21 Apr 2007 23:42:14 -0400
>
>Layperson trainings vary greatly in terms of time and content. There is no
>generally accepted standard as to what constitutes an appropriate first aid
>curriculum other than the recent ILCOR first aid proceedings and the 
>NFGATOS
>project. Formal training organizations may grant more structure as
>completion of given programs require certain skills to practice (American
>Red Cross, AHA, ASHI, NSC, and others).
>
>OPAs are a skill at the 40-hr First Responder curriculum... but should not
>be taught at any level under that.
>
>I think that simply not teaching it would be counterproductive. A student
>who sees that you do not teach them how to insert an OPA may feel
>short-changed by you in terms of not learning something he/she might find
>valuable/cool/useful/important (or any other adjective). If it is so
>widespread and common to teach, if I were you, I would simply dedicate less
>than 1 minute to say why anybody who is not  a healthcare provider should
>NOT insert an OPA without further knowledge on airway anatomy, proper 
>sizing
>and proper practice time if the current training program does not allow for
>all of them.
>
>Just my $0.015's worth of opinion.
>
>Gustavo E. Flores Bauer, MSIII EMT-P :.
>Iberoamerican University School of Medicine
>Santo Domingo, Dominican Republic
>
>web: www.emergencyteam.net
>e.mail: gflores at emergencyteam.net
>
>"My karma ran over your dogma."
>
>
>-----Original Message-----
>From: trauma-list-bounces at trauma.org 
>[mailto:trauma-list-bounces at trauma.org]
>On Behalf Of oded private
>Sent: Friday, April 20, 2007 1:43 PM
>To: trauma-list at trauma.org
>Subject: Re: OPA, lay persons,and regulation of training in Israel and 
>world
>wide
>
>
>Of course, both the EMS and the army teach this (to EMT's, paramedics, 
>etc.,
>
>not to lay persons) with the apropriate manikins, but I'm talking about
>private firms. Most training is for lay persons, but some is for EMT's who
>don't work for the EMS but for private transport ambulance companys, and
>need refreshment, and rarely there are courses who train people as "medics"
>(I have no idea what they are realy authorized to do by law). These people
>are trained for work places as responders, and go through about 2 weeks or
>even more of training. This is done WITHOUT proper manikins.
>
>About the NPA- it's actually very rarely seen here.
>
>Just to make clear, I do not teach lay persons the OPA, but this is an
>exception and in contrary to "policy" if one can call it that way.
>
> >From: "Forrest Robleto" <farcpr at gmail.com>
> >Reply-To: "Trauma &amp; Critical Care mailing list"
> ><trauma-list at trauma.org>
> >To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> >Subject: Re: OPA, lay persons,and regulation of training in Israel and
> >world wide
> >Date: Fri, 20 Apr 2007 13:22:11 -0400
> >
> >I teach lay providers all the time and we do not teach OPA.  It is part 
>of
> >the EMS basic training that I teach but we teach them on a intubatable
> >manikin and teach them how to insert on an unconscious person with NO gag
> >reflex.  If they have a gag reflex they are taught to go with an NPA if
> >indicated (No head trauma etc.)
> >
> >On 4/20/07, oded private <tangentcarrot at hotmail.com> wrote:
> >>
> >>Hello dear list. My two subjects concern trauma and EM training of lay
> >>persons, a field in which I've been working lately (but not anymore,
> >>probably, as I'm just about to quit).
> >>
> >>First subject- OPA's
> >>Lay persons are routinely trained to use the oropharyngeal airway in
> >>uncouncious victims.
> >>Not only that the literature says that OPA's are to be reserved for use 
>by
> >>health care providers only (and my own common sence and expreince tell 
>me
> >>just the same), "training" usually occurs with manikins such Laerdal's
> >>"Little Anne", which are not designed to have an airway inserted and 
>CAN'T
> >>have an airway inserted. Meaning, training is done, as we call it here,
> >>"methodically".
> >>By the way, the airway IS relevant to lay persons in terms of
> >>availability-
> >>since they do sell it in first aid packs.
> >>
> >>I find it very disturbing- I don't think lay persons can always 
>accuratley
> >>determine unresponssiveness, not to mention absence of gag reflex.
> >>Moreover,
> >>the use of the OPA requires training  either with appropriate manikins 
>or
> >>in
> >>the OR. You can't get it right- neither the technique  of insertion not
> >>the
> >>thechnique of measuring the right size from having someone tell you 
>"it's
> >>done that and that way".
> >>
> >>What do you think?
> >>
> >>Second subject-
> >>
> >>In the diffrent countries and districts you come from, how is the 
>subject
> >>regulated?
> >>Here, as far as I know, the answer is quite simple- it's not...
> >>As far as I know, private companies don't have standarts for competency 
>of
> >>instructors, nor do they have committing guidelines from the ministry of
> >>health or the ministry of education.
> >>A freind of mine just had a 4 days long first aid&CPR course. After the
> >>first day he showed what he was taught in CPR- and I had to tell him
> >>"that's
> >>not right, that's obselete, that's wrong, that's irrelevant..."Turns out
> >>his
> >>instructor is a former instructor from the military (perhaps a good one, 
>I
> >>don't know), and according to her age she has been out of the army for 
>5-6
> >>years. I find it hard to believe she has had formal training or
> >>"refreshment" since then. Besides teaching things that arw wrong, he was
> >>taought many things that are simply unimportant- on the expense of hands
> >>on
> >>practice.
> >>Even instructors who just got out of the military my be under-trained in
> >>istructing lay persons, as guidelines differ between health care 
>providers
> >>and lay persons.
> >>
> >>I'd like to hear your opinions, thoughts, and local knowledge on
> >>regulation
> >>as well. It's quite disturbing my rest.
> >>
> >>I know that some of the giants of Israeli trauma- Michael Stein, Avi
> >>Shapira
> >>and Eran Tal-Or write here. I'd be more then happy to hear any comments 
>or
> >>insights you may have. Perhaps you do have some information about this
> >>subject which I don't know.
> >>
> >>_________________________________________________________________
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> >>
> >
> >
> >
> >--
> >V/R
> >
> >Forrest Robleto
> >R House Health & Safety
> >www.RHouseTraining.com
> >FRobleto at RhouseTraining.com
> >609-792-9047
> >--
> >trauma-list : TRAUMA.ORG
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>
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OPA, lay persons, and regulation of training in Israel and world wide