I was first certified for CPR and First Aid sometime after I turned 18 but before I graduated college. There's a Red Cross facility not far from the college I went to so I remember taking a long, single day course that covered Infant/Child and Adult CPR with AED followed by First Aid. I got another long course when I was a camp counselor followed by a refresher class just before I started student teaching. Once I landed a teaching job, I signed up to be on the Medical Emergency Response Team for my school so I got a full-day course on CPR and First Aid yearly plus I got to participate in random emergency drills throughout the school year.
ATI manages to forget the first rule of first aid response - be safe. At my very first CPR class, the instructor got us all on the floor with our dummies and gave us this scenario: "You walk into a Red Cross training room and find 15 people unresponsive on the floor. What do you do next?"
My classmates launched into detailed triage ideas.
I said, "Get the hell out of there and call for help. Fifteen people down means something really bad like a gas leak, stray voltage, or an axe murderer and I don't want to be number 16. Especially if it's an axe murderer. "
Yup. I know when I'm completely inadequate for a job and I know when to call for help.
Once you've verified that there's not an immediate danger, you check to see if the person is really unconscious by yelling at them or flicking at their feet if they are a baby. Being a camp counselor is even more fun when any counselor who drifts off to sleep in a moment of downtime immediately has another counselor screaming "Are you ok? Name, ARE YOU OK?" at them. (I do have a quirky sense of humor, I admit, but I had fun.)
If they are unconcious, you check to see if they are breathing. If they are not, you move into the ABC's of cardiopulmonary resuscitation where "A" stands for airway, "B" stands for breathing, and "C" stands for "Circulation" or "Compressions". The idea is pretty straightforward. First, a rescuer checks to see if the airway is open by tilting the head and lifting the chin to prevent the tongue from blocking the airway. If the person doesn't start breathing, the rescuer administers two rescue breaths. Once the two rescue breaths go in, the rescuer either checks for a pulse or begins chest compressions.
It's not complicated - yet ATI manages to fuck that up:
First aid procedures are created to remedy the most common life-threatening health issues in a target population first. For adult victims, the most common cause of cardiorespiratory failure is cardiac issues so solo first aid responders are taught to call for help before starting chest compressions because the sooner a victim has access to an AED and cardiac life support the better their chances of survival. In contrast, infants and small children have a much higher rate of respiratory failure and choking than adults do so solo responders are instructed to give one minute's worth of breaths and compressions before calling for help.
Civilian responders are unlikely to run to a situation where the main cause of cardiorespiratory failure is catastrophic bleeding - but ATI manages to even mess that up! Military members in combat have a much higher chance of treating a comrade who has had a traumatic amputation with massive bleeding. Because of that, soldiers are trained to apply tourniquets to amputated limbs before beginning CPR. If ATI was aping military first response, the "bleeding" section should be moved first. Equally importantly, ATI does nothing to differentiate massive, life-threatening bleeding from a nasty laceration that can wait until the person is breathing with a heartbeat.
ATI next moves into an EFG mnemonic that I cannot find anywhere. Don't get me wrong; there are protocols for life-support that include "EFG" - but they are not for minimally trained civilian responders and none of them involve E = eyes, F = fractures and G = Get help.
Having "Get Help" come last makes no sense. The best thing a first responder can do is to get the attention of another human being who can call 911 and send fully trained emergency responders to the rescue. During one of MERT team drills, our slightly sadistic nurse-trainer decided to keep all of the other adults "trapped in an office" while I was stuck with a downed student in another room that didn't have any dangerous situations. I started the ABCs while screaming like a stuck-pig. I'm not kidding; I let out a series of blood-curdling screams. Suddenly, the room was filled with teenagers who bailed from the class next door to see what was going on. I called the name of the most responsible one and told them to pretend to call 911. Not exactly what our trainer expected - but hey, I got the attention of someone with a phone. Problem solved. :-)
In ATI-land, "E" is where the responder checks for pupil size and responsiveness and protects the head and neck. The Red Cross and the American Heart Association both train civilian responders to hazard an educated guess about head and neck injuries in the initial airway phase. If there is more than one responder and a head or neck injury is suspected, a different way of opening the airway by thrusting the jaw down and out is used by the responder who is keeping the head and spine immobilized. If there is only one responder, the head tilt-chin lift is used because the responder needs to be at the person's side instead of stationed above their head.
Doing a quick check to see that the person is neurologically ok is probably not going to hurt at this stage - but in my experience civilian first responders like me spend more time keeping the injured person calm and gently encouraging them to not move around. Frightened injured people do really weird shit under the influence of "fight or flight" so focusing on keeping them from hurting themselves worse will probably pay off more than staring intensely at their eyes.
Speaking of bad ideas, ATI also recommends "gently pressing" on people's bodies to look for fractures or joint damage.
That's insanely bad advice for so many reasons.
People in fight or flight can react violently to another person intruding in their personal space. A few years ago, I had a bad case of pleurisy that landed me in the ER. Every breath caused pain to shoot through my rib cage so I was breathing very rapidly and very shallowly and my heart-rate went through the roof to try and compensate. The pain was so bad that I couldn't talk - but when my blood oxygen level started to drop, a lot of people came in the room. I was so out of it that I would try and hit anyone who touched me. According to my husband, the medical staff took it all in stride because this happens a lot apparently. Someone talked to me quietly and calmly and I let them put the cannula on me.
If a person is not in fight or flight, the responder can simply ask them if any of their limbs hurt.
And let's be honest. ATI has a horrible history when it comes to molestation. Let's not give cult members any reasons to start feeling up injured folks, ok?
If you want to be trained in CPR or first aid, there are plenty of places that provide both trainings like the Red Cross or the American Heart Association.
OMG I don't even understand why they would publish this. The basics of CPR and first aid are widely published, there's no reason for ATI to make up their own.
ReplyDeleteI'm trying to imagine what scenario they think people are in when using this advice. Hiking in an isolated area or finding someone attacked by a bear when camping are kind of the only times I can imagine it wouldn't be better to simply check the airway, give a couple breaths and call 911. For crying out loud.
And checking their pupils? Feeling for fractures? I think these guys should be careful, actually. They could get sued by someone who was injured WORSE by a "rescuer" following ATI's advice.
So ATI/IBLP used to have an entire medical training arm called Medical Training Institute of America (or MTIA). I the bulletins are sometimes cross-referenced in the Wisdom Booklet and in my naivety I at first assumed that MTIA was some sort of reputable civilian training org like the Red Cross.
DeleteThankfully, MTIA is completely and totally defunct now - but I am really scared about what kind of shit they taught IBLP members before they folded.
One of my cousins is an ER doctor. Thanks to Rick Santorum's inane advice for students to learn CPR in case of school shootings, my cousin let all of us know that CPR is actually contraindicated in gunshot wounds that have caused mass bleeding (or any other uncontrolled mass bleeding) - because forcing the heart to pump when there is uncontrolled bleeding increases the speed at which the person bleeds out without doing any benefit.
That's why wilderness medical classes include portions on determining if a person can be saved and methods for palliative care if a wounded person is going to die before rescue.
I think some of this is their eternal arrogance. In their imaginations they are big, important rescuers. But doing the hard work of learning a profession...well, that might expose them to the fact that they are neither so big nor so important.
ReplyDeleteSo instead, they play act with ragged scraps of information and a blithe indifference to reality.
I am afraid you are right! ATI has a series of camps - I mean, life changing trainings *rolls eyes* - for teenage girls. Really, the only activities that seem to be geared toward teenagers and not junior high students is the CPR/First Aid training (assuming they are using a real course) and technical rope training including river crossings. The rest is stuff I remember doing at camp in 4th-8th grade like "wilderness survival" where we learned how to build fires and shelters, going canoeing, and orienteering. They have a whole home-repair and auto repair section, too - but I learned that from my parents as I grew up.
Delete