Thursday, November 01, 2012

Conflict Zone First Aid Training

     In response to a prior post on blow-out kits, several readers have asked about conflict zone first aid training. Here’s a quick rundown of what’s available in the U.S. and my thoughts on the different options (international readers, feel free to mention training options in your part of the world in the comments below).

Red Cross training – When it comes to first aid courses, most organizations default to one or two day classes offered by Red Cross chapters. There’s certainly nothing wrong with these courses, as they provide some good, basic skills. However, when it comes to conflict zones, you need to be aware the training has a few limitations. First, the classes assume professional emergency medical response is nearby and only a phone call away (obviously not the case, in most developing countries). Second, the classes don’t go into detail about what you may encounter in conflict zones (such as gunshot wounds, blast injuries, and multi-trauma). And finally, the courses don’t cover proven combat lifesaving procedures and equipment the military has developed over the past decade. (The adoption cycle is typically military followed by firefighters, EMTs, and paramedics followed by the Red Cross.) I feel everyone should have some basic first aid training. And if you’re going to be working in a high risk environment, it’s worthwhile to supplement the basics with additional skills related to trauma. Do a Web search for “red cross first aid” with your location to find scheduled classes.

Wilderness First Responder (WFR) – I often recommend Wilderness First Responder (commonly called WOOFER) training for humanitarian security practitioners who do a lot of field work. Designed for wilderness search and rescue team members and outdoor guides, the course assumes there is no nearby hospital or ambulance. This is ideal training for austere conditions that exist in many developing countries (the instructors also teach a proper mindset and how to improvise when it comes to first aid supplies). The class is very practice-based and there are lots of opportunities to use hands-on skills that you’ve learned. It has a much greater depth and breadth than a basic first aid class (as evidenced by the multiple-day, 80-hour duration). While the trauma modules don’t specifically cover typical conflict zone injuries, they are much better in scope and detail than what’s found in basic Red Cross first aid courses. If you don’t have the time or budget, there are also shorter Wilderness First Aid and Wilderness Advanced First Aid classes. I’d recommend any of these over Red Cross offerings due to their austere environment focus. The downside to these courses is they aren’t as commonly offered as Red Cross classes. A number of organizations offer these wilderness courses, some of the more notable include: NOLS, RMI, SOLO, and WMA.

(As a footnote, in the hierarchy of the U.S. emergency medical system, the progression is First Aider, First Responder, Emergency Medical Technician, and Paramedic; each having a higher skill level and the ability to provide more definitive care than the previous.)

Tactical First Aid classes – A number of firearms training facilities are now offering half to two day courses that cover tactical first aid. In these classes, students are taught how to treat gunshot wounds and provide care under fire. There’s typically an opportunity to use military-developed tourniquets and hemostatics (bandages that slow bleeding) that come in blow-out kits. Course content tends to be very applicable to conflict zones. However, consider that the primary audience for these training schools is law enforcement officers, soldiers, and people who legally carry concealed firearms. This culture tends to be very different than that of the humanitarian community. If you have sensitivities about firearms and gung-ho, military approaches, this type of training probably isn’t for you. However if you can keep your focus on just learning the skills, the training can be valuable. Google “tactical first aid” to find various class offerings.

Custom training – An alternative to attending a scheduled class is to hold a group training that’s tailored to your organization’s needs. Most companies that offer scheduled courses will also provide custom instruction. Look for an experienced instructor who “gets” NGO culture and above all, make sure there’s a good fit with him or her and your organization. Unless it’s an awareness class, hands-on practice with the type of first aid supplies you plan on using is a must. There aren’t many first aid instructors exclusively catering to the humanitarian community, but I expect that may change in the future (with the war in Afghanistan winding down, you’ll likely see more instructors with combat medic experience in the marketplace).

Self directed study – Last but not least, there’s self study. When it comes to learning first aid skills, you really can’t beat a good instructor and hands-on practice. But if that’s not available, being familiar with some knowledge and skills can be beneficial.

I’d start by getting a copy of “Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry” by Buck Tilton. This is the textbook for the WFR course. It’s well written, easy to understand, and has evolved and improved over the years (now in its third edition).

For coming up to speed on military protocols for treating trauma encountered in conflict zones, check out the Tactical Combat Casualty Care resource page. You’ll find videos, guidelines, checklists, and other reference material. Many of the skills require advanced training, so stick with basics, which include: tourniquets (CAT = Combat Application Tourniquet), Combat Gauze, and patient carry techniques.

If you’re interested in medical treatment that goes beyond first aid, I strongly recommend any of the Hesperian health guides. Especially, “Where There Is No Doctor.” Used all over the world and translated into 26 languages, this classic and highly regarded book sets the standard for taking complex information and putting it into a format virtually anyone can understand and use. Buy a paper copy for your library (or pack) or freely download the PDF version.

     And finally, in closing, always remember the Latin “Primum non nocere” which means “First, do no harm.”



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