Feedback on an important document

I need to give emergency first-aid guidelines to my university cave club for our upcoming expedition. The current guidelines are outdated and inappropriate to our circumstances. We have access to helicopter emergency assistance, but if an incident occurs underground it will be many hours (say, eight hours) before that help could arrive.

This is a first draft of the document. Any feedback welcome, especially from people with a medical background.

http://www.snarkpit.com/pits/gollum/bls_guidelines.zip

*To add: signs of profound hypothermia</A></B>

your link is dead.. make it a true link mike.. even copy/paste fails :sad:

Worked for me, Orph.

Capitalize the title and bold more words. That's as far as I can suggest.

Link should be fixed now.

snarkpit, thru trial and error from both lep and i have determined, that the pit hates caps..

make all files in lower case, to assure functional links.

/ 2 cents

Orpheus said:
snarkpit, thru trial and error from both lep and i have determined, that the pit hates caps..

make all files in lower case, to assure functional links.

/ 2 cents

Tick

If it doesn't work now, it's definitely a problem at your end :wink:

Nothing to add except I laughed at the bit where it advises against administering CPR to a decapitated head. :biggrin:

maybe i misunderstand, but this is a document for after someone needs help..

why not have one to avoid getting into trouble to begin with?

perhaps, you already covered this while i was on the road mike?

did i miss something?

Gollum said:
Tick

If it doesn't work now, it's definitely a problem at your end :wink:

oh, i went into your pit directly and retrieved it mike.. no hassles.. i was just attempting to forestall any future issues.

i have had cap issues with critiques in the past.. lep and i determined it is best to only use lower case files..

Orpheus said:
maybe i misunderstand, but this is a document for after someone needs help..

why not have one to avoid getting into trouble to begin with?

perhaps, you already covered this while i was on the road mike?

did i miss something?

The guidelines to avoid getting into trouble are really more about safe caving and risk assessment than medical matters. As one of the least experienced cavers on expedition, it's not my place to educate people about caving (rather, I'm there to be educated!). As medical officer for the expedition, it is my responsibility to give advice about first-aid etc.

Nothing to add except I laughed at the bit where it advises against administering CPR to a decapitated head. :biggrin:

Well, you have to include it. Besides, a bit of macabre humour is essential for these grim speculations :biggrin:

i know basic first aid only, nothing major i am afraid.

i am more inclined to educate on avoiding injuries.. good luck with your position mike.. its an important one to be sure.

spelunking can be very exciting, but the novice... i hate them. i have no fun when i cave with complete n00b's, the caves i visit, tend to be reject of people who know better than to be in them :biggrin:

have fun.

Caves with campers and awp fagz suck. Spelunking heh, sounds almost as dirty as hornswoggle.

Nicely done. it is straight forward and concise. you may want to say something about how to recognize hypothermia, but that may be beyond the scope of this document.

Make sure you watch out for rolling boulders, they can be a real hazard :wink:

Tracer Bullet said:
Nicely done. it is straight forward and concise. you may want to say something about how to recognize hypothermia, but that may be beyond the scope of this document.

Yes, I do need to mention that. People can probably recognise hypothermia, but they won't know the differences between hypothermia and profound hypothermia.

wil5on said:
Make sure you watch out for rolling boulders, they can be a real hazard :wink:

Yes, it would be ironic wouldn't it :biggrin: Some club members have had close calls with rolling, or at least falling, boulders. We have something called the "Lemming" award for these people.

Over wordy Gollum, you say too much when what you are trying to achieve is getting people to understand the fundamental ideas in the document..

numerous examples, far too many to mention

eg;

"Instead, I will address these two emotive questions" - could be I will answer the two most important questions.

This isn't Shakespeare, and without wanting to sound rude, I am aware you have an extremely wide vocabulary. This isn't the kind of document you need to exercise it on :wink: People tend to zone out and ignore the most important things in text if you waffle or overword - just go and remove some of the less needed modifiers..

"ventricular fibrillation" - this isn't ER. simplify for safety, not everyone will have their medical dictionary to hand or will understand this.

the use of the word him, is a little odd - perhaps it is better to call the person, the casualty.

the use of the word ventilation - "mouth to mouth" would be preferable. no doubt if (god forbid) a situation should arise where your guidelines have to be remembered/used, they need to be simple, practical yet accurate... not the entire medical lexical set :razz:

like Cass said as well - use of bold, and bullet points to highlight the most important points to remember. it reads far too much like a handbook than a set of guidelines.

No offence, but as it stands it is far from straight forward - no doubt some people can understand the language and terminology used, but you cannot guarantee everyone will click with your style of writing and excessive over modification of words.

When making a document like this, you have to think about the target audience, the information (and more importantly which bits are "vital" knowledge). Sorry if it sounds like i'm being an anally retentive bitch, I just have done this lots before - reading, criticising and reshaping documents for maximum effect :smile:

Gwil said:
the use of the word him, is a little odd - perhaps it is better to call the person, the casualty.

Gwil, are you in the WI or something?! "Him" is a generic, neutral gender title so it's perfectly acceptable, unless this has to be politcally correct :rolleyes:

mong, i clicked edit instead of reply... still havent woken up fully :razz:

lep: political correctness I hate, just because i'm on the left it hardly means I advocate pandering to the whims of liberals and whingers. you couldn't be further off the mark in fact :razz:

the document is comprehensive, but far from clear and concise (or as clear/concise, as it could be). as an english language student (a particuarly good one, without wanting to blow my trumpet) I picked documents apart on so many topics, and rephrased and rewrote them for maximum impact on an almost daily basis.

i am casting my critical english eye over this, so it is effective - after all, it is quite an important document :razz:

as for the use of the word "him", i'm not saying women cavers will feel victimised or anything, I couldn't care less what they call each other. I just think the term "the casualty" keeps the subject of the sentence, and the entire document uniform - thus leading to better comprehension of the points and instructions Gollum needs to convey :smile:

I have only one thing to add. Remind everyone that the best
place to check for circulation is the throat right next to the adams
apple. Chest compressions on a still beating heart may do more damage
than good.

TBH if it was me writing the document, or I had a free hand to whip the editing axe on it, a layout overhaul is needed as well. these things may seem like a passing though - perhaps sections/questions to head up the different areas.

like Background, Assessing the casualty (you see Lep, thats why its important :razz: ), When to use CPR, etc - this will help people learn and comprehend MASSIVELY. Never undervalue structure and layout in maximising the effectiveness of a document.

angel of death said:
I have only one thing to add. Remind everyone that the best place to check for circulation is the throat right next to the adams apple. Chest compressions on a still beating heart may do more damage than good.

Not true. Lay rescuers (as opposed to healthcare professionals) are now advised not to check for a pulse. This is because they will take far too long and will be unreliable. Chest compressions to a still-beating heart are unlikely to cause serious harm, but failing to give them to a stopped heart is certain death.

But thanks for giving your input, I appreciate it :smile:

Gwil - thanks for the detailed feedback :smile: I agree that the document is not worded effectively for a basic first-aid guide. But that isn't its purpose.

No offence, but as it stands it is far from straight forward - no doubt some people can understand the language and terminology used, but you cannot guarantee everyone will click with your style of writing and excessive over modification of words.

When making a document like this, you have to think about the target audience, the information (and more importantly which bits are "vital" knowledge).

Exactly. The target audience are all very intelligent people with wide vocabularies and good knowledge of basic first-aid principles. Their training has also included elements of advanced first-aid. I am not going to repeat everything that they already know - that will bloat the document and make it less likely to be studied.

I'm aware of the increasing emphasis on simplicity and clarity in instructional docmentation. I'm also aware of the elements of English courses that teach this. I think on the whole it is a very good idea, but it can become too single-minded. I've recently had to read a lot of this sort of stuff (for my sports coaching qualification) and to be honest I find it very tiresome and hard to digest. Apt use of "sophisticated" vocabulary is a better way to communicate, provided that your audience understands the vocabulary. I recognise it's necessary and desirable to "dumb down" when instructing a very broad audience, however.

The purpose of this document is not to teach people first-aid. They already know that. It's intended to fill a gap in their knowledge - an area where they are unsure. There's no point in me rehashing D.R.A.B.C. etc.

TBH if it was me writing the document, or I had a free hand to whip the editing axe on it, a layout overhaul is needed as well. these things may seem like a passing though - perhaps sections/questions to head up the different areas.

Now there I think you may be right. I want to retain all the information in the document, but I think I should start the document with clear guidelines before offering the detailed medical explanation. That way, those who like to follow rules will happily read the guidelines and understand them; those who like to question rules will read the justifications and accept them.

Gollum said:
Exactly. The target audience are all very intelligent people

i don't wanna quote this completely out of context, cause it may have no baring at all on this one occation..

highly intelligent, or educated people can and often are the most stupid people i have ever encountered.. no offense to anyone in particular here, but when it comes to real smarts, book smarts hold no comparison :sad:

my education extends only slightly past 12th grade, as far as schooling goes, but i have had the displeasure of training several of my supposed bosses... bosses who's only qualification was a college degree.. usually in a subject that has nothing to do with the job at all :sad:

bottomline.. assume they are stupid, not educated, and write the document accordingly, cause really smart people, are dumb as door knobs..

Maybe I should have said that these people are smart and experienced. I'm working with very good "raw material" here.

However, I will revise the document structure to improve clarity :smile:

Gollum said:
Maybe I should have said that these people are smart and experienced. I'm working with very good "raw material" here.

However, I will revise the document structure to improve clarity :smile:

just as long as you know, i meant no offense.. i don't know your friends, so my opinion cannot be entirely directed at them now can it :smile:

my spelunking experience is somewhat limited, but i know my limits.. and thats all incumbent when caving.

good luck mike.

I had half-guessed your target would be well educated people, but the points stand for general use, but I can see your point :smile:

So yeah, the only thing I guess is just a bit of a layout workaround. Also I did forget to say it seems like all good, usable information.. just spinkifying is needed :smile:

Don't forget to show us the revised version :wink:

And don't forget, pictures = win

Gwil said:
I had half-guessed your target would be well educated people, but the points stand for general use, but I can see your point :smile:

So yeah, the only thing I guess is just a bit of a layout workaround. Also I did forget to say it seems like all good, usable information.. just spinkifying is needed :smile:

Don't forget to show us the revised version :wink:

Will do :smile: Despite everything else I've said, I believe the skill of "cutting down" a document to its bare essentials and presenting it with maximum clarity is very important (and it's not nearly as easy as many people might think!). At the moment the document is badly organised.

Good, useable information as Gwil said, though not enough.

What are the signs of profound hypothermia? How can they be distinguished from those of near-drowning?

The document is clear and well written, a nice, easy style. I would
hate to think that my life might depend on someone who found it
difficult to understand - don't go caving with troglodytes is my advice.

On a different note, I intend to complain, in the strongest terms, to
the Basic Life Support and Automated External Defibrillation Working
Group about their scandalous use of the word "him" throughout the whole
document you cite as a reference. :smile:

I've changed the document structure and style, and I'm revising the advice on cold water immersion/profound hypothermia/near drowning. These are the really tricky cases and they need to be crystal clear :smile: Will have to stop soon because I need to do some "real" work :wink: But I'll update when finished.

Right, here's a new version. It's radically different from the previous one - I've tried to take your comments to heart without destroying the good things about the document. Let me know what you think.

• Draft 2

1) assuming everyone has word here at the pit, might reduce your feedback, have two versions.. word/wordpad.

2) 20 minutes huh? it actually says that? if i need cpr, i hope you lose your watch.

i love the new layout mike, and must confess i didn't read the whole thing, other than to note all the metric crap :biggrin: i assume all your chums know it?

final; inquiry, all this is basic CPR, are you only doing CPR or is this just #1 of many?

actually, maybe i should read it closer, the thing is not making sense to me...

( i have both, this and the word document open as i type )

i will get back to you.

Glad you liked the new layout - it was some effort to get Word to do what I wanted

20 minutes huh? it actually says that? if i need cpr, i hope you lose your watch.

If I found you unconscious in a road accident in this country, I would attempt to give you up to four hours of CPR. That's because I would be waiting for the ambulance to arrive.

In a remote cave, it's going to be more than four hours before help arrives. You are as good as dead in that situation if a short period of CPR is not effective. My concern is for the safety of the group as well as the casualty.

Remember that CPR is not nearly as effective as a natural heartbeat. CPR cannot keep someone alive forever.

You've illustrated my ideas very well though - it's precisely this sort of irrational, emotional reaction that is likely to make people give pointless CPR and potentially endanger themselves :wink:

final; inquiry, all this is basic CPR, are you only doing CPR or is this just #1 of many?

Just this one. Remember, they have received first-aid training; this document is meant to correct a specific gap in the training. I also need to look at the extraction of patients with suspected spinal injuries, but that's not something everyone needs to know about - before we start moving a casualty out from the cave, I will arrive to make an assessment (or my deputy will if I've gone home already).

That said, I should think about integrating this with the general rescue guidelines.....but that's a task for another day :smile:

my concern was 2 fold.. cpr warms the person doing it as much as helps the victim to survive..

your wording assumes, no one went out for assistance.. if i knew the entrance was 60 minutes at a trot each way, i would be giving cpr for no less than 120 minutes..

secondly if you were one of two members present only, and your safety was paramount, then 20 minutes is a good number.

i admit, i have limited first aid training, but it is much more extensive than you seem to be grasping.. i know all the military first aid :biggrin: .. much more than your average office first aid officer would have. i could in a pinch, deliver a normal birth if i had to.. when i say limited, i am saying i know much less than a nurse/doctor.

anywho's.. conditions would dictate just how long i did the action.. a bit of common sense so to speak..

/me shuts up now :smile:

your wording assumes, no one went out for assistance.. if i knew the entrance was 60 minutes at a trot each way, i would be giving cpr for no less than 120 minutes..

Suppose it's 60 minutes to the entrance. It's then probably another 60 minutes back to base camp or the nearest phone reception area. Helicopter response time is another 60 minutes, and then they have to get down the cave. Another 60 minutes before they reach the casualty.

In total, 4 hours is the response time. The casualty is dead by then.

However, if you were just inside the entrance - say, 10 minutes caving - the time is cut to 2 hours 20 minutes. This might just be short enough - that's why I say "Unless you are very near the cave entrance....".

admit, i have limited first aid training, but it is much more extensive than you seem to be grasping.. i know all the military first aid :biggrin: .. much more than your average office first aid officer would have. i could in a pinch, deliver a normal birth if i had to.. when i say limited, i am saying i know much less than a nurse/doctor.

Sorry, I didn't mean to snub your knowledge. It sounds like you know quite a lot more first-aid than I do :smile:

as i said, a bit of common sense mike.. if john doe is dead already.. 4 hours of cpr is a bit extreme..

also, you must know, i rarely get more than 1 hour deep.. i have very limited resources.. i use no ropes and such, but amateurs like me rely on flashlight batteries.. and 20 pounds of them suck ass.. i don't leave dead ones inside.. so i have to haul them both ways.

also, i didn't mean to snub either.. i assumed you knew all military personnel take basic first aid for battle conditions..

sorry my bad.. i didn't mean to flaunt.. i am not here to steal your thunder..

Flashlight batteries for your lights :eek: An LED would be a good investment. They last for 40-100 hours on a single battery.

Gollum said:
Flashlight batteries for your lights :eek: An LED would be a good investment. They last for 40-100 hours on a single battery.

really, you got a link? i have no idea what you mean.. nothing i have ever owned would last more than 60 minutes of constant use..

/methinks you thinking pro spelunking.. /me is basic wal-mart variety caver..

Orpheus said:

Gollum said:
Flashlight batteries for your lights :eek: An LED would be a good investment. They last for 40-100 hours on a single battery.

really, you got a link? i have no idea what you mean.. nothing i have ever owned would last more than 60 minutes of constant use..

/methinks you thinking pro spelunking.. /me is basic wal-mart variety caver..

Caving gear isn't cheap, but it isn't too expensive either. Might be worth checking out what prices you can get in the U.S.

I have one of these on order (the 7 bulb variety): http://www.speleo.co.uk/fxled.html . It cost me about ?30 for the reflector/LEDs, ?5 for the halogen bulb and ?42 for the headset/cable/battery pack. So ?78 in total. That doesn't include a protective helmet (worth making sure any lights you purchase will fit your helmet).

I get a discount through the club - we're unofficially sponsored by Ben Lyon - so I don't know what normal retail prices are. Guess: + 20% extra.

Halogen uses much more power. I almost always cave on LEDs; halogen is just to focus a powerful beam on something.

For the prettiest light, though, use carbide. Only slight drawback is that you can set yourself on fire :heee:

have not seen carbide in 20 years.. am not even sure its available anymore.. at least not on your average store shelves..

i will check into that light.. looks coolness :smile:

now.. i have taken enuff of your threads time.. back on topic peeps :biggrin:

Nice work, Gollum. Well laid out, informative and concise. A huge improvement on the first draft.

? posted by Orpheus

.... all the metric crap :biggrin:

This made me laugh - a lot.

Gollum said:
Right, here's a new version. It's radically different from the previous one - I've tried to take your comments to heart without destroying the good things about the document. Let me know what you think.

• Draft 2

bump

Anyone else? Gwil-mong?

Much better Gollum :smile: The use of bold to emphasise the importance of the main points, and structured layout makes the whole thing a lot easier to read and more importantly, comprehend :smile:

Can't see much wrong with it, as now it's mainly technical/terminology changes and clarification.

Much, much better :smile:

Gollum said:
Flashlight batteries for your lights :eek: An LED would be a good investment. They last for 40-100 hours on a single battery.

According to my flatmate LED's use no electricity at all, they just need a current to make them work, but then again he smokes a lot of the wacky backy and drinks far too much gin

What the hell do you think a 'current' actually is? They still need energy to turn into light, which they can't do without a battery...

LEDs are very efficient though, which I suppose accounts for that sort of silly misconception. I personally only use LEDs for outdoor stuff. it gives you a great sense of security to know that your batteries will last several days of continuous run time.