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Royal Life Saving produces National Drowning Report 2016 [PDF]
This report examines drowning deaths in Australia between 1 July 2015 and 30 June 2016.

❝ Many of those who drowned were not swimming when tragedy struck – 46 people were boating immediately prior to drowning, while 39 lost their lives after falling into water. ❞

❝ Men and boys were far more like to drown than women and girls, accounting for 83 per cent of drowning deaths over the 12-month period. ❞

❝ 25% decrease in drowning deaths in rivers. ❞

drown

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A re-post from visibleprocrastinations.wordpress.com March 4, 2016;

While researching a scenario used in a Remote Area First Aid course last weekend, I have been introduced to a whole new area of Outdoor Education literature that exists with respect to fatality analysis and the outcomes which inform fatality management – a process above, and separate to, safety management, risk assessment and risk management;

Safety planning can be mired in trivial detail, distorted by institutional practicalities, diverted by the requirements of insurance claim managers, confused by optimistic jargon (‘best practice’, ‘quality assurance’, ‘legally covered’) and captured by the promoters of particular training or accreditation schemes. It may be based on theories which have paid insufficient attention to the available empirical evidence from the outdoor education field and the wider literature on safety management. [Brooks (2003a)]

The focus has shifted too. The emphasis in the current standard (Standards Australia and Standards New Zealand, 1999) is very much the protection of organisations themselves from ‘something happening that will have an impact upon objectives’ … The possibility of serious physical harm seems very much tacked on the end in this description. I’d argue that in a hierarchy of adverse consequences, death or serious injury to persons involved is right at the top of things we want to avoid. [Hogan (2002)]

The primary references for this have been published by Dr Andrew Brookes (see reference list below), and includes Scouting within the description of Outdoor Education. The fatality analysis papers lists known Scouting fatalities within the data sets but would not be a comprehensive collection of these incidents. I recommend reading through the papers in order as they build a clear picture from the incident analysis. I feel that this set of papers gives an interesting view to then reapply to our standard risk management process to double check – ‘have we allowed for fatality management?’.

Why is this important?
For many Venturer level activities the program not only recommends, it defines, the removal of direct supervision of activities (eg. Queen’s Scout level Expeditions). The Outdoor Education literature is pretty clear that we are organising a high risk activity with this requirement;

Some would argue that there is educational gain in teaching individuals, or a group, outdoor skills and then slowly removing the supervision of those learners so that the students become increasingly dependent on their own skills and judgment. My contention is that society is not sympathetic to this approach when safety is compromised for the sake of education. This sentiment is supported by recent coroners’ reports into the death of participants on outdoor education programmes.. I find it difficult to justify the removal of direct supervision of activities involving high levels of risk. Further, I believe that management personnel who condone such practices are placing themselves at risk of criminal prosecution by doing so.. [Davidson (2005)]

In some instances the boys were unsupervised as part of a deliberate program aim, in one or other variation of the ‘boys taking an adult role’ theme that has entered some forms of outdoor education from the early twentieth century youth movements. … ‘Indirectly supervised’ (i.e. not directly supervised) expeditions for teenagers present a clear fatality risk if there is a possibility of the group encountering moving water or steep ground. [Brooks (2003b)]

From a Venturer Leader’s perspective this means;

i.) Enhanced supervision is required if encountering moving water or steep ground, and it is best avoided if supervision cannot be guaranteed. This includes if this terrain is at the periphery of a planned activity;

The tight supervision that organized instruction necessitates (in activities such as abseiling, or canoeing) should be in place while students are near steep ground or moving water, i.e. not only while the activity is in progress. The fact that students may actively escape supervision or take advantage of a supervisor’s inattention should be considered. [Brooks (2003b)]

ii.) An examiner, having worked through the training, planning, equipment and competence of a QS Expedition should also ensure that a deviation from the planned route does not result in an unaccompanied party encountering moving water or steep ground; there would be a legal debate regarding Duty of Care owed if an unaccompanied party was to get into trouble under these conditions “a knowable event”. Has the examiner met the task of minimising the risk exposed by the identified hazards, such that the risk is reduced to an acceptable and justifiable level for the educational outcomes achieved?

The literature is also very clear that a supervisor should have local knowledge of the area being used for the expedition. These issues have also been given further weight via coronial reports (see Davidson (2005)).

In the two examples, both groups had received training prior to the unaccompanied trip, had been well equipped and had been deemed competent to undertake the trip by an experienced instructor who had observed them in similar terrain. In both cases, when hazardous terrain was encountered, and the group made poor judgments on the ways to deal with those hazards, no experienced leader was able to intercede and prevent serious injury from occurring. [Davidson (2005)]

Teenagers generally are more willing than adults to gamble what they can’t afford to lose. It is not that teenagers feel invulnerable, or do not weigh up risks and benefits, but rather they will make bad choices more often than adults if left unmonitored, and might be willing to try things adults would not contemplate. [Brooks (2007)]

This would require that all unsupervised expeditions have an analysis of what hazards exist if the group were to get off route. (In practice, the easiest way to ensure the hazards are managed is to shadow the group and move into the group when hazards are encountered. This method is now the recommended practice outside of Scouting.)

Several extremely important precautionary recommendations come from Brookes’ research;

1.) SUPERVISION: Teenagers, especially boys, must be effectively supervised around steep ground and moving water, especially at times when they are not involved in an organised activity. In hazardous conditions they (particularly boys) can tend to take risks that adults would not, most specifically around steep drops and moving water.

Teenagers generally are more willing than adults to gamble what they can’t afford to lose. It is not that teenagers feel invulnerable, or do not weigh up risks and benefits, but rather they will make bad choices more often than adults if left unmonitored, and might be willing to try things adults would not contemplate. [Brooks (2007)]

2.) The importance of planning how to coordinate an emergency response, including being able to detail your exact location and how it can be accessed by paramedic assistance. Fatality prevention requires emergency communication to be planned and tested, including contingency arrangements should the preferred method fail.

… the incident reinforces the observation that an emergency involves a ‘change of state’ from what may be a well-planned activity to a new and different activity that might not be well planned. Trip planning should include planning access for emergency services, and working through how to communicate locations unambiguously and effectively. [Brooks (2007)]

3.) ALLERGIES: The need for supervisors to understand and be prepared for severe allergic reactions. The timely use of an Epipen can save a student’s life.

4.) To view large-scale visits to pools or other swimming locations with considerable caution (particularly ‘end of the year’ celebrations)

5.) BULLYING: To be aware that outdoor activities might offer particular opportunities for bullying or worse, as “these particular behaviours tend to occur when the attention of supervisors is otherwise engaged, even if momentarily”.

6.) WEATHER: Weather can render a usually safe activity unsafe.
Environmental circumstances, including weather, remain paramount. A change of weather can move an activity beyond the boundaries that were planned for, creating a new unmanaged activity.

Many of the incidents here occurred when weather conditions transformed a planned activity into something completely different. [Brookes (2004)]

7.) ENVIRONMENT: The environment is a more important factor than the activity undertaken for educational activities involving dependent youth. There are exceptions (such as downhill skiing), but in many instances the only relevance of the activity is that it explains why the group or individual were in the fatal location. Activity skill might be a more important factor in some forms of adult recreation.
Outdoor education fatality prevention, at least in principle, should focus primarily on environmental hazards. Activity expertise is not sufficient to ensure fatality prevention. For fatality prevention, supervisors must have the knowledge and experience to recognise, and avoid or neutralise hazardous environmental conditions.

Rescue situations involve what is often a sudden ‘change of state’ from normal operations. Teachers or supervisors can find themselves transported from a situation that is well-planned and comfortably within their experience to a situation that is unplanned, unplanned for, and outside their experience in a matter of minutes. Rescue planning requires specific, deliberate attention in any fatality prevention process; it cannot be assumed that because a program runs smoothly and has a good record it will not descend into chaos in a rescue situation. [Brookes (2003b)]

… outdoor education involves novices; fatality prevention can hardly be based on presumptions of expertise. All students make mistakes, and most students learn only some of what they are taught. Students may become ill and unable to exercise skills they have. Participants in some forms of outdoor recreation may seek out situations in which there is little margin for error, but outdoor education, like all education, requires situations in which it is safe to make mistakes. [Brookes (2004)]

8.) To prevent fatal incidents supervisors must attend to supervision and environmental hazards for the entire duration of an outdoor education excursion. Safety planning which focussed just on the activities would fail to account for the many incidents which occur before and after planned activities, or which involve a victim who was not actually participating at the time.

9.) Adult supervisors can be victims

10.) FIRST AID & RESCUE: First aid failures are hardly ever identified as contributing to a death, but rescue glitches (i.e. logistical problems) sometimes are. First aid can save lives in certain kinds of situations, but most incidents are not of that kind. If a Risk Management Plan is only covering first aid and is ignoring rescue/evacuation it is not managing the higher risk issue;

… it is clear that not many, if any, fatal outcomes were contingent on the quality of first aid provision. Rescue is another matter. Rescue and first aid are linked to the extent that ‘seek qualified medical assistance promptly’ is a first aid imperative, but rescue also includes retrieving a situation before it becomes a first aid matter or worse. I found evidence to support the view that better planning for a possible rescue could have saved lives. [Brookes (2003b)]

11.) Informal excursions can be prone to problems due to lack of clarity about supervision responsibilities

REFERENCES:

Brookes, A. (2003a). Outdoor education fatalities in Australia 1960-2002. Part 1. Summary of incidents and introduction to fatality analysis.
Australian Journal of Outdoor Education, 7(1), 20-35.
http://www.latrobe.edu.au/education/downloads/brookes_a_OE-Fatalities1.pdf

Brookes, A. (2003b). Outdoor education fatalities in Australia 1960-2002. Part 2. Contributing circumstances: supervision, first aid, and rescue.
Australian Journal of Outdoor Education, 7(2), 34-42.
http://www.latrobe.edu.au/education/downloads/brookes_a_OE-Fatalities2.pdf

Brookes, A. (2004). Outdoor education fatalities in Australia 1960-2002. Part 3. Environmental circumstances.
Australian Journal of Outdoor Education, 8(1), 44-56.
http://www.latrobe.edu.au/education/downloads/brookes_a_OE-Fatalities3.pdf

Brookes, A. (2007). Research update: Outdoor education fatalities in Australia.
Australian Journal of Outdoor Education, 11(1), 3 – 9.
http://www.latrobe.edu.au/education/downloads/brookes_a_oe_fatalaties_in_Australia.pdf

Brookes, A. (2011). Research update 2010: Outdoor education fatalities in Australia.
Australian Journal of Outdoor Education, 15(1), 35 – 55.
http://www.freepatentsonline.com/article/Australian-Journal-Outdoor-Education/267429089.html

Davidson , G. (2004) Unaccompanied Activities in Outdoor Education
New Zealand Journal of Outdoor Education, 1(4),
http://outdoorsvictoria.org.au/wp-content/uploads/2014/12/UnaccompaniedActivities_Davidson_NZJOE_2005.pdf

Hogan, R. (2002). The Crux of Risk Management
Australian Journal of Outdoor Education, 6(2), 71 – 79
http://www.wilderdom.com/pdf/Hogan2002V6N2RiskManagement.pdf

Rather than list other references, it is worthwhile using the reference lists within these papers to expand the reading list.

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Personal First Aid Kit

You will often be asked to pack a “personal first aid kit” for Scouting activities, but what do you carry in such a kit? You should pack the kit to match each activity, the gear for a long bush walk (blisters?) may be quite different from that you would take SCUBA diving (reef rash?). Make sure that you know how to use the items in your kit, and that they are within their expiry dates.

The Scouts Australia – Victorian Branch InfoBook 2012 (page 94) lists the following kits and contents;

FIRST AID KITS: SCOUT KIT (PERSONAL)
• One triangular bandage
• One 7.5 cm crepe bandage
• Small wound dressing (No 13)
• Four adhesive dressings (Bandaids)
• Three safety pins
• Plus any personal medications (This needs to include paracetamol and any anti-hystermines as prescribed for your own use. Ant and spiders bites prevalent.)

FIRST AID KITS: PATROL KIT
• Roll of adhesive dressing strip
• Packet of gauze squares
• Five Betadine wipes
• One wound dressing (No 14)
• One pair of shears
• Adhesive tape – 2.5 cm wide roll
• One bottle saline solution
• One set of plastic tweezers

FIRST AID KITS: GROUP KIT (SCOUT HALL)
To be taken on all major events & standing camps, etc. This should be an unlocked, weather proof and easily transportable box or pack, to be kept in an accessible location and scrupulously maintained with up to date stock.
• Four triangular bandages
• 5 pair of disposable gloves
• Two 5 cm crepe bandages
• 12 assorted safety pins
• Two 7.5 cm crepe bandages
• Small pack cottonbuds
• Two 10 cm crepe bandages
• 10 Betadine wipes
• Small box of No 13 Cotton Squares (Dove or similar)
• 4 disposable cloth wipes
• One large wound dressing – No 1535 gm
• Foil rescue sheet
• One small wound dressing
• Small notepad and pencil
• Ten wound closures – Steristrips
• 30+ Sun Screen cream –verify allergy before use
• 20 adhesive dressing (Bandaids)
• Adhesive tape – 2.5 cm wide roll
• Adhesive dressing strip
• Four non-stick dressings
• Four eye pads – sterile
• 6 bottles saline solution
• Pair of sharp scissors or shears
• Pair of plastic tweezers

Detail from the 2016 Info Book
2016-info

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Royal Life Saving is deeply alarmed to see that the numbers of drowning deaths are the highest they’ve been at any time in the last 7 years, with 314 drowning deaths in Australian waterways between July 1st 2009 and June 30th 2010.
Royal Life Saving CEO Rob Bradley says following on from the previous year (where the number of drowning deaths jumped by 16%) there’s now been another increase, which may point to an alarming upward trend in drowning deaths.
In the past 2 years the number of people drowning in Australia has increased by close to 21% – after a period of time where the number of drowning deaths was steadily dropping. …

2010 National Drowning Report (2010-Sep-22) [Royal Life Saving Society – Australia]

Our Cub Scout Boomerang award system has an area specifically dedicated to water safety, and the dangers inherent to water activities;

BOOMERANG – TEST # 2 SAFETY – PART # 4 WATER

Bronze:
a.) Discuss the dangers of swimming in the type of waters in your area.
b.) Explain the dangers of inflatable toys in open water.

Silver:
a.) Demonstrate an understanding of the dangers of swimming in swimming pools, rivers and lakes, the sea and by dams.
b.) Identify safe areas for swimming.

Gold:
a.) Show three methods you could use to help someone who fell in deep water and cannot swim.

It is useful when discussing water safety to have access to real data to assist in analysing areas of risk. This is where Royal Life Saving Society – Australia’s 2010 National Drowning Report is very good at providing real information, of particular interest for the questions asked in our badge work are;

(i.) the ‘locations of drowning deaths’ and the activities/sex/age group analysis for each of the locations

(ii.) Drowning Deaths by Age and Gender

(ii.) Quick Facts on Drowning

Interestingly the swimming achievement badge doesn’t also cover these issues.

Royal Life Saving says children – particularly those under 5 years – are the most vulnerable to drowning. They highlight that child drowning is preventable and that the Royal Life Saving Keep Watch Program (www.keepwatch.com.au) offers critical actions to highlight that close constant and focused supervision is important plus restricting children’s access to water; water awareness and ensuring people have up-to-date resuscitation skills. Royal Life Saving reminds all Australians to regularly check pool fences and says improved pool fencing legislation is needed.

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CPR to the beat

Planning a First Aid practice night? Perhaps you should also bring along your sound system to have a CPR soundtrack playing to assist with the compression timing;

Researchers claim that the Bee Gees 1977 tune “Stayin’ Alive” is a great track to pace yourself when doing CPR. The song’s tempo is 103 beats per minute, very close to the 100 chest compressions per minute recommended by the American Heart Association. For the last two years, the AHA has been suggesting trainees practice to the song. [1]

But Nadkarni said he has seen “Stayin’ Alive” work wonders in classes where students were having trouble keeping the right beat while practicing on mannequins. When he turned on the song, “all of a sudden, within just a few seconds, they get it right on the dot.”
“I don’t know how the Bee Gees knew this,” Nadkarni said. “They probably didn’t. But they just hit upon this natural rhythm that was very catchy, very popular, that helps us do the right thing.”
… [2]

What other 100bpm tracks do you think could be appropriate for CPR training? Some tracks may be more appropriate than others 😉

Studies have shown the importance of immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest improve survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 30 percent. In cities such as New York City, without those advantages, the survival rate is only 1-2 percent. [4]

[1] Disco for CPR (2008-October-17) [BoingBoing]
[2] ‘Stayin’ Alive’ has near-perfect rhythm to help jump-start heart (2008-Oct-17) [CNN]
[3] WFR CPR “Another One Bites The Dust” (2008-Aug-28) [YouTube]
[4] Cardiopulmonary resuscitation [Wikipedia]

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Experts call to end first aid’s ‘kiss of life’
In a controversial move, the Australasian College of Emergency Medicine has recommended that mouth-to-mouth ventilation be abolished from national cardiopulmonary resuscitation (CPR) guidelines and replaced with chest compressions only, saying the move would save more people.The recommendation comes after two prestigious overseas studies found patients were more likely to survive without brain damage if CPR was administered without mouth-to-mouth.But the Australian Resuscitation Council (ARC), the peak body overseeing CPR guidelines, is resisting recommendations despite last year slashing the rate of breaths to compressions and eliminating pulse checks.Dr Stephen Bernard, of the Australasian College of Emergency Medicine, told The Sunday Telegraph latest research showed compression-only resuscitation was the best way to improve survival.(…)

A study published in the Journal of the American Medical Association this month found patients of emergency workers who delivered compression-only resuscitation were three times as likely to survive.

— (2008-Mar-30) news.com.au

Minimally Interrupted Cardiac Resuscitation
Minimally interrupted cardiac resuscitation (MICR), a novel protocol for out-of-hospital cardiac arrest, includes an initial series of 200 uninterrupted chest compressions, rhythm analysis with a single shock, early administration of epinephrine, and delayed endotracheal intubation. To investigate whether MICR is associated with improved patient survival, Bobrow and colleagues (SEE ARTICLE) instructed emergency medical service personnel from 2 urban Arizona fire departments in MICR and assessed patient survival before and after instruction. In a second analysis, the authors reviewed data from 62 Arizona fire departments (12 trained in MICR) and compared survival among patients who received MICR vs those who did not. The authors report that survival to hospital discharge increased after implementation of MICR and was higher among patients who received MICR compared with those who did not. In an editorial, Peberdy and Ornato (SEE ARTICLE) discuss critical determinants of cardiac arrest survival and progress in resuscitation techniques and protocols.
This Week in JAMA: JAMA. 2008;299(10):1105.

Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital…
Bobrow et al.
JAMA.2008; 299: 1158-1165.

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BRONZE, SILVER, GOLD 1. Health – First Aid
# Explain how to use a mobile phone and a public phone and discuss the steps you would take to make an emergency call.

two_scouts_on_the_phone.gif

ICE – In Case of Emergency
Nearly all of us carry a mobile phone with names & numbers stored in its memory but nobody, other than ourselves, knows which of these numbers belong to our closest family or friends.
If we were to be involved in an accident or were taken ill, the people attending to us would have our mobile phone but wouldn’t know who to call. Who is the contact person in case of an emergency?

An initiative conceived by a paramedic in Britain, is trying to solve this problem. The idea is that you store the word ICE in your mobile phone address book, and against it enter the number of the person you would want to be contacted ‘In Case of Emergency’. For more than one contact name ICE1, ICE2, ICE3 etc could be used.

In an emergency situation ambulance and hospital staff can then quickly find out who the next of kin are, and be able to contact them. This could save a life, or put a loved one’s mind at rest. Not only does it help emergency workers identify a person if they come upon them unconscious, it also helps identify the owners of lost cell phones. — Florenz Ronn, ABC

ICE will allow ambulance crews and other personnel to quickly contact a nominated person who can be informed in the event of an incident.

Mobile phone owners should type the acronym ICE followed by a contact name (for example, ICE – mum or ICE – David) into the address book of their mobile phone and save the phone number. They should also agree and inform their ICE contacts of the arrangements.

Reach for your phone now and make that new entry in your contacts list. You never know when you’ll be In Case of Emergency.

And if you don’t carry a mobile phone, how about carrying an ICE card instead?

Mobile Emergency Number
While we are discussing mobile phones, another number for your contact list is the Mobile Emergency Number. The Emergency Number worldwide for Mobile is 112. No cell cover? 112 can be dialled in any area covered by GSM, whether it’s within your mobile phone company’s coverage area or not, and without having to unlock your keypad or key in your security-protection pin number.

Emergency call service
This is an operator-assisted service that connects you to an emergency service organisation such as police, fire or ambulance services in a life-threatening or time-critical situation from any phone at no charge.

Dialing 000 will connect you with emergency services from any fixed, mobile or pay phone.

You should only call the emergency call service in a life-threatening or time critical situation.

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