First Aid/CPR

[Rushforth]

I'm not going to post on https://www.facebook.com/RugbyRefscom but:

"Considering nearly every game has a ref, should every ref be a 1st aider? Not for a cut finger, but for the urgent medical situations where the seconds & minutes matter. What real reason is there not to be a first aider if the training is provided?"

There is a reason I am posting in "Referee Only Forums => Bad Experiences".

Please ignore the poor automatic translation http://translate.google.com/translate?hl=en&sl=nl&tl=en&prev=_dd&u=http%3A%2F%2Fwww.rugbyclubsparta.nl%2F. Besides having been a friend of mine for more than half my life, he became a role model for many of us here in Holland. His 16-year old son attempted resuscitation, but sadly we lost a friend, a referee, and the chairman of a great club to a heart attack.

Some fifteen years ago, I qualified as a BSAC (sub-aqua) diving instructor. One of the prerequisites is first aid. First aid with a component of 90% CPR. My instructors had all dealt with cardiac arrest "in the field", be that on the beach at Hurghada or on the street somewhere in Europe. Few survived, particularly the ones that had the disadvantage of hearts stopping due to drowning.

Two years ago, some 20 minutes into the "next" match, I was informed that one of the players I had just seen victorious less than an hour ago had passed away. Also of a heart attack.

All referees, coaches, and senior players should be aware of http://www.irbplayerwelfare.com/ (e.g. http://www.irbplayerwelfare.com/?documentid=module&module=9&section_id=76) We should not force anybody to "qualify", particularly not referees.

That said, first aid training should be offered, free or for a nominal charge (can't have the trainer make a loss) to all referees (and others, but above all, referees).

My free of charge first aid course for referees without first aid experience:
1) Whistle, stop the game.
2) Do not be attempt to be the first-aider.
3) Above all, manage the situation.
4) Delegate; if an ambulance is necessary have it called by someone within a minute.

Because: you can keep your head when all about you / Are losing theirs and blaming it on you. (http://www.kipling.org.uk/poems_if.htm)

First aid in a bad situation is team-work. Let the teams in your match take care of their stricken. Do not let concussed players return to the field of play. This probably applies to players with broken legs, arms, or scrotums too.

Unless you are a medic or paramedic, there will be at least one amongst the 29 remaining players, let alone the substitutes and spectators who is better than you in treating the injury or condition, and there will be another better at treating the player in a funk with a broken ankle or shin-bone showing.

There will rarely be anybody better placed than you to take command of the situation and ensure that appropriate assistance arrives.

 

[ballsie]

As an EFRI and divemaster I would be very hard pressed not to step up and give first aid to any one under any circumstances
unless of course there was a more qualified person present
If a victim has suffered a cardiac arrest he or she is technically dead, you giving aid aint going to make them any deader..
its your choice at the end of the day... you have to life with it...
aequate care is better than no care at all

 

[barker14610]

The success rate of CPR is very low. In fact, when you look to 30 day survivals after CPR, the rates are extremely poor. And, until you have been in a room trying to save a dying/ dead patient, you have no idea what it is like. Realistically, without experience, most people would panic. While it seems like a good idea for everyone to learn CPR, without proper equipment and advanced cardiac lifesaving medications, you have little to no chance of success. From Circulation

Modern published studies of resuscitation for cardiac arrest (all cardiac rhythms) show rates of survival to hospital discharge that range from 1% to 25% for outpatients64,66–69 and 0% to 29% for inpatients.70,71 A compilation of the mortality statistics from the largest of these recent studies is reported in the Table, revealing overall survival rates of 6.4% after out-of-hospital arrest and 17.6% after in-hospital arrest. Survival varied greatly by initial cardiac rhythm, with higher success rates for resuscitation from ventricular arrhythmias and markedly worse outcomes if asystole or pulseless electric activity was initially noted. My italics here. What this means, is that someone who's heart stops(asystole) due to a heart attack will not survive. And, ventricular arrhythmias need outside intervention to correct almost always.
To be clear, I am not saying learning CPR is a bad idea, or that trying it is. But, understand that expecatation of success is low. In fact, nearly 60% of the people you "save" on the pitch will be DOA at the hospital.

 

[Browner]

if i'm reading this correctly[?] .... 6.4% 'out of hospital arrests' don't survive, then my CPR attempts to be one of the 6.4% ..... I think i'll still continue, because i'd never know if my 'arrestee' is one of those, or the one that might nudge the stats up a tad.

 

[dave_clark]

alternatively, why not designate every captain as first aider? or every winger? to choose the referee seems to be yet another thing being put as "someone else's problem".

had the rule been in place when i started refereeing, i don't think i would have done it.

Rushforth, my sincere condolences on the loss of your close friend.

 

[winchesterref]

I am CPR/sports trauma trained due to my previous work. I have never interfered as a referee, and only once as a player - though this was a potentially serious neck injury and the bucket and sponge man was trying to roll the player and I said to him "just what the fck do you think you are doing!" and took over from there to put him on a spinal board and have him seen by a paramedic.

I don't think it should be a requirement, but those who have the skills should be covered to use them if they choose to without fear of liability and law suits. Only if I saw something inherently unsafe from a club member would I think about going in to ask/do something about it, and check (for my own peace of mind if nothing else), but I wouldn't want to be the "go to" man on the field for anything like this, not my responsibility to provide adequate cover.

 

[Dixie]

And another thing ... there are a lot of total morons out there who would try to sue your ass

I was reffing a youth game when a saw a very awkward tackle - tackler on the floor and dazed, possibly unconscious. I whistled, and knelt by the lad to check his airway. All clear, so I gently touched his shoulder and told him the coach was on his way, there was no rush, time was off and he should just take his time. Coach arrives, screaming at me not to touch his player, threatening all sorts of consequences to myself, just who the f*&k did I think I was - etc etc.

Let these people be the ones to shoulder the medical responsibilities for their charges - they desperately seem to want it. (I'm sure Didds is an honourable exception)

 

[Browner]

And another thing ... there are a lot of total morons out there who would try to sue your ass

I was reffing a youth game when a saw a very awkward tackle - tackler on the floor and dazed, possibly unconscious. I whistled, and knelt by the lad to check his airway. All clear, so I gently touched his shoulder and told him the coach was on his way, there was no rush, time was off and he should just take his time. Coach arrives, screaming at me not to touch his player, threatening all sorts of consequences to myself, just who the f*&k did I think I was - etc etc.
)

Tell the coach that you are the person who permits him access to your pitch !! His blusterings have no weight , just because you encounter a prat it doesn't make his pratterings valid!

 

[Phil E]

You can't be sued for administering first aid.
They told us this on our first aid course at work, and every refresher.
There is a special law that covers it, but I can't remember what they called it. Might have been the Good Samaritan act?

So for instance if you break someone's ribs giving them CPR, they can't sue you afterwards for assault.

 

[crossref]

obviously having first aid training is a good thing, but I think rushforth gets it right above: typically the referee can contribute most in any emergency by being the guy with the cool head in the crisis.

 

[Robert Burns]

My point for the above was not to remove a clubs responsibilities, or to make it a requirement for every ref to be a first aider.

My point is that considering every game has a referee, why not encourage refs to be first aiders. Not to fix minor cuts, but to be first in if a player has a serious life threatening condition where every second counts.

I know the stats for CPR, but surely one life saved makes all the effort worth it? Most refs are also not trained in emergency management, rush was fortunate he had this skill.

A by product if being a trained first aider will be an increased ability to recognise injuries that a player shoukd not be allowed to continue with.

I would hazard a guess that probably at least 50% of refs are already first aiders, the fact that they are advised not to use it if needed is a cery sad reflection on our society in my opinion.

I respect an individuals decision to not get involved, as they need to be confident and sure of what they're doing. But if your work told you not to help anyone that was hurt in your office, would that be ethically right?

The other benefit being that your training may actually be needed when it is a friend or family member that needs it. It certainly isn't only for the rugby pitch.

 

[SimonSmith]

A little learning is a dangerous thing.

We're lucky here - all our College teams are mandated to have an Emergency Responder pitchside.

You know the other reason I'd be uncomfortable, aside from the fact that I have no medical inclination and believe it should be the club responsibility? I want to be able to keep calm for my serious injury report. Because if the injury is that bad, there's going to be paperwork for a multitude of reasons

 

[OB..]

When this was last raised at my society, it was stressed that medical support is a club responsibility and should not be diluted by the assumption that the referee will provide cover.

Individual referees can decide for themselves if they want first aid training, but they should not be eager to volunteer their services unless absolutely necessary.

 

[Toby Warren]

A little learning is a dangerous thing.

We're lucky here - all our College teams are mandated to have an Emergency Responder pitchside.

You know the other reason I'd be uncomfortable, aside from the fact that I have no medical inclination and believe it should be the club responsibility? I want to be able to keep calm for my serious injury report. Because if the injury is that bad, there's going to be paperwork for a multitude of reasons

Is it that bad stateside that a fear of not being able to complete the paperwork holds you back from considering doing the training?

(To be fair I support 100% the concept that it's the clubs' role)

 

[Daftmedic]

Good Samaritans act. Speaking as someone who is trauma trained. The only time I have ever got involved as a player or otherwise is
a) compromised airway
b) unconcious victim as you treat them as (a) with c-spine control. (If a suitably qualified person is not present or local contract medical cover have tried to sit an unconscious person up).
All unconcious patients due to trauma are required to have c-spine immobisation. *phtls

 

[colesy]

There is no Good Samaritan Act in any of the UK jurisdictions.

The following extract indicates that it is certainly possible for a first aider to be deemed negligent and held liable in damages if he falls below the standard to be expected of an ordinarily skilled first aider:

'The unreported case of Cattley v St John Ambulance Brigade (1988), which considered the standard of care owed by a first-aider, is a rare instance of someone suing a volunteer. First-aiders from St John Ambulance assisted a teenager who had been taking part in a motorcycle scrambling event and had fallen off his motorbike. The judge held that ‘[The volunteer rescuer in question] or any other person holding himself out as a first-aider trained in accordance with [the First Aid Manual] would be negligent if he failed to act in accordance with the standards of the ordinary skilled first-aider exercising and professing to have that special skill of first-aider’ and went on to say ‘the true test for establishing negligence in a first-aider is whether he has been proved to be guilty of such failure as no first-aider of ordinary skill would be guilty of, if acting with ordinary care. If in any situation the first-aider acts in accordance with the first aid manual and does so with ordinary skill, then he has met the test and he is not negligent’.

 

[Browner]

So that's the answer, .....arrive, declare yourself a novice 1st aider incapable of anything & then ask whether you have consent to proceed !:sarc:

 

[Daftmedic]

1988. That's scraping the bottom of the barrel.
http://www.sa-cni.org.uk/uploads/4/9/5/4/4954631/the_legal_status_of_those_who_provide_first_aid.pdf

 

[SimonSmith]

It may be old, but unless there has been superseding law, it's precedent and therefore binding.

is it that bad in the States? I hope that I don't have to find out, But given the tendency for jury awards to err on the side of ****ing huge, I'm careful. And having been through deposition professionally, I'm very aware of the need to be exact and precise in what you say.

#paranoid referee

 

[Daftmedic]

As far as I can work out. There hasn't been a ruling yet. And I've defiantly done past the reams of "first aid" to road traffic collisions I have unfortunately come across