The Irresponsibility of ‘Fairy Dusting’

CarolinaFireJournal - By Adam Reading
By Adam Reading
01/10/2015 -

More than 25 years ago, I stood alongside a rural road at the scene of a two-vehicle MVA with six casualties, four critical. I had no medical training and watched in awe as teams worked to extricate the victims. Ambulances, fire trucks, police cars and helicopters came and left. The sights, sounds, smells, and overwhelming sense of helplessness left an indelible impression on me. Something brought me to that scene and several weeks later I was enrolled in an EMT-A class at a local hospital. Does my story sound familiar?

The unfortunate reality is that notional training (AKA fairy-dusting) is a chronic disease that is largely left unchecked and considered an acceptable norm.

Years later I would share that story with every EMT class I instructed. I’d ask my students to reflect inwardly and question why they chose to become an EMT. Many stated that they “wanted to give back to their community,” others “because my job requires me to be here,” and a few would say that they didn’t know why, but “something brought me” to the class. The next words out of my mouth needed to give them purpose for being there, a sense of responsibility when wearing the Star of Life, and motivation to commit themselves to being an EMT. Not just an EMT, but one that takes the responsibility of trust very seriously. Pretty deep thinking for the first 15 minutes of class...

As with most EMS education departments, I had a “dollar menu” budget and relied on expired medications, equipment that was opened and not used as well as hand-me-downs from other departments that afforded me the opportunity to “adopt” their equipment before they threw it in the dumpster. My intubation training head was nearly as old as I was and held together with whatever I could find. During one training lab I asked a student to identify landmarks when intubating. After a few agonizing seconds of looking around with the laryngoscope, I asked what was taking her so long. She laughed and said, “I’m looking for the duct tape, because I know the epiglottis is right behind it.”

Her comment was a wake up call. I needed to up my game in order to meet my student’s expectations of their training, and, more importantly, what they will see in the field.

The following comments are a culmination of numerous training observations while working with all levels of EMS, fire, military, and DoD response teams. I’m offering my insight because I have found that the chronic educational disease “Fairy dust” is still quite prevalent, even in highly revered agencies.

It was about 0400 when I heard the recon teams working through the wood line. Suddenly an artillery simulator detonated nearby, temporarily deafening me and ruining my night vision. Machine gun fire erupted from several directions and the chaotic directions from team leaders sent soldiers to establish a perimeter and check for wounded. “Wow” I thought, “this is high speed training.” Weeks of preparation would be tested here in the pre-dawn hours. The early morning humidity made the sulphurous smell of smoke grenades stick to the back of my throat. As I followed a team to a pre-staged casualty, my enthusiasm hit a brick wall. There he was, sprawled out like a frog that had been run over, wearing a uniform that was no longer in use and moulaged injuries that looked like he had been a clown in a military circus. Team members circled around him to assess his “injuries” and applied tourniquets. They all carried medical bags fully outfitted with appropriate gear, but none of them were allowed to open the bags and use the equipment. (Imagine their surprise when they have their first major trauma and wrappers, packages, equipment, etc. is spread out all over the place.) “Oh, and don’t cut the uniform, we don’t have funding to buy new ones.” Imagine my excitement anticipating them to do blood sweeps and seeing realistic blood on their hands, properly applying chest seals, starting IVs under a poncho with a flashlight in their teeth ... but wait, the blood was not applied to replicate the injuries, the sucking chest wound was discovered when the instructor told them it was there, the chest seal never came out of the packet, the IV and tubing was all verbalized. Physical exams consisted of them feeling with their hands, but looking to the instructor for assessment findings. Sure the evaluators were there, yelling at them when they messed up, but the only thing realistically portrayed was the explosions and ensuing chaos. There was more fairy dust at this active duty-training center than there is at Disneyland.

Another gross example is when I supported a very large-scale government exercise where hundreds of thousands of dollars were spent in moving tons of medical equipment, portable medical tents, and hundreds of personnel for a weeklong exercise. As I surveyed the dozens of mannequins pre-positioned on wheeled litters, I saw laminated cards on each one. When I asked the exercise coordinator to give me a top-down overview of the exercise, she explained that the mannequins were victims of an explosion. I smiled and asked her to follow me over to a nearby “victim.” Without even looking at the victim, I reached behind my back and found the laminated card. I read it word by word to her and asked if there was anything wrong with my assessment/findings. She said “No, that’s the information they get when they receive the victim.” My reply, “With all due respect ma’am, I’ve not even looked at the patient. You are assessing my ability to read.”

The unfortunate reality is that notional training (AKA fairy-dusting) is a chronic disease that is largely left unchecked and considered an acceptable norm. I believe that many “alphabet courses” are the biggest offenders. Bottom line is that in order to create realism, you cannot compress time, nor prohibit participants from using equipment. Not just any equipment, it must replicate what they are using when they are responding, down to the bag and location of gear in the bag. Sure there is a time and a place for using old 4X4s and recycled oxygen delivery equipment, splints, etc. I’d suggest reserving that equipment for individual skill stations.

We all crave creative training approaches, especially when we deal with topics that we manage everyday. I argue that PowerPoint should only be used when absolutely necessary to cover key points. Skill sheets are a performance record, not a checklist. Invest the time and recruit talent to make your training MEMORABLE!

At the end of the day it comes down to these simple truths:

  1. Fairy dust should only be found in magical gardens.
  2. Patients are people and their conditions are not notional.
  3. Equipment not used in training will not be used efficiently when needed.
  4. More sweat in training means less blood in combat — you make the correlation.
  5.  As EMS providers, we are afforded blind trust from our patients because we wear the Star of Life.
  6. Train your crews to the level that you trust them with your life.

Adam Reading is a 20-year veteran Paramedic and EMS educator. A retired Air Force Chief Master Sergeant (Medic) with 30 years of service, he has spent the majority of his life committed to military and pre-hospital care and training. A self-described “dirt medic,” Reading has focused his education and career on disaster preparation and response. He has supported numerous Fire/EMS, USAR, FEMA, Department of Defense and Department of State exercises and has presented at several international conferences.
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