gabri- May 19th, 2015
Longest teaching article I've written in a long time...
Endurance Event Nursing
Endurance event nursing can be very varied depending on the event, but does have many similar aspects apart from many other nursing opportunities.
Focused- Instead of holistic care of a person, there is the focus to get from Point A to Point B alive and in the best possible condition. Most training and work in nursing is very encompassing- the entire person, health history, family, finances, resources available- with the goal of long term health and wellness. The patients you may help are also much focused- walk the 5k, 60 miles, or win the tournament. They are committed to this goal, sometimes with great emotional or financial stake. They (mostly) have spent hours of training, getting equipment, possibly fundraising with a single goal in mind- to finish the event. They may be walking for a friend or family fighting a disease, or someone who is lost to them. No one wants to be in that first aid tent, and it can be very crushing. You have a common goal: for them to finish the event. When finishing the event is not a safe option anymore, challenges arise. It may be providing emotional support; it may be having to put a foot down on someone who wants to keep going. For the most part however, it is adults who are participating, and the choice to stop or continue is ultimately up them.
Knowledge of your patient- usually very limited, bare bones. There is no hand off report on the 10 to 800 people in your care. The type of event will give you an idea of the population you may be treating and the type of injury or medical problem you might face. Athletic tournaments- karate, medieval reenactment fighting, and wrestling- are usually with very well conditioned athletes. Same can be said for marathon or speed running. Fun Runs and charity walks have a spectrum of ages, degrees of general health, and extent of pre-training. With any event, there is also the audience or supporters who may end up in your care.
Resources- usually very limited. This reflects back to focus. If it is not possible to get them back to walking or running the route, or back to competition, they need to move to a different level of care. The amount of resources you many have will depend on the duration of the event, the organization hosting, and expected type of injury. Sometimes volunteers are expected to provide the medical supplies as part of their volunteer service.
Documentation and communication-. Largely, you will work closely with people who are not licensed health care workers. Fun Runs generally do not have any paperwork. Organized walks, runs or athletic competitions within an established group generally do have paperwork. The paperwork in this group is a lot less CYA and a lot more giving the group a clear picture of what risk there are with an activity, and how to lessen them in the future, or focus the limited supplies to what is needed to treat that. Do not use medical terms or abbreviations.
Liability- Huge variation again, but always something you have to look at. If you are only providing First Aid, there is very little potential liability. Do they have insurance covering first aid providers? Is there an overseeing MD or NP with their license on the line? What are the limitations of the care you are allowed to provide onsite, if any? Good Sam Laws only go so far in protecting licensed professionals like RNs. You can win a civil suit and still lose your license if the nursing board of your state determines you did not provide the equivalent care to the standard of your community. This does not mean you are committed to provide that care; it means you must have acknowledged that the need for care exceeded the resources and scope of the event and recommended continuing care.
Depending on the type of event, it will change the resources possible, and the focus of the expectation of needed care, and the population expected. I have not had the opportunity as yet to volunteer for a marathon, but I would like to give some thoughts on the variations between the types of volunteer First Aid care I have been able to give as a volunteer nurse.
Fun Runs
Focus- Fundraising. Usually very low impact, low risk. There may be a section for speed competition, but this is generally populated by much trained runners who train for small events heavily. Most common injuries are from falls- bruises, scrapes and sprains. These are not common, and your usual role is to be eyes on the route to call in a bigger problem and generally cheer, give encouragement and give warning about route hazards. Experienced event organizers will put RN’s as the highest risk areas for falls- slopes and hills. For the most part, get out your pom-poms, cheer like mad, yell to slow down on the hill when it just rained, enjoy the day, and get your volunteer t-shirt.
Knowledge of patient- Total random. Babes in arms to grandma carrying them. Again, it tends to be short, so falls are your biggest worry.
Resources- Very usually none. I suggest carrying a few band aids for road rash on a slip and trip. Over a 5k you might get a radio (Important tip- make sure the batteries are good, and you know how to use that model and it’s on the right channel). Generally, there are no radios, and rely on yell. Know your distance to call for help. “3rd Kilometer on grassy slope- elderly female down” is much more helpful than some where mid-route someone fell.
Documentation- None, unless the freakish happens and you're calling in EMTs. You may be asked to write what you saw, where it happened and why, and what was done.
Liability- Tiny. Low risk event with no expectation of medical event.
Prolonged Event Endurance (Susan G. Koman 3Day)
Focus- Fundraising and awareness. Population varies enormously. The most common injuries are blisters and heat injuries. At this writing I am chagrined to realize I do not have the link to an amazing blister care tutorial written by Dr. Jennifer. If you would like this, please contact me personally at heather@lazzaretti.org, and will forward the link when I get it from a former crew member. I am providing a hand out on heat injury. Following this- diabetic control issues, electrolyte imbalance, exacerbation of COPD or existing cardiac disease, hypothermia, and… viral infections from URI to GI.
Knowledge of patient- Much more random then might be expected. Anywhere from young athletes who train 5 days a week to pregnant women, elderly men and women, people who went on one training walk for 2 miles 4 months before, cancer patients still in treatment, walkers in walking boots, walkers pushing another “walker” in a wheelchair. Full bodied and amputees (loved the guy in the Blister Care area who told me he couldn’t feel his right foot with a straight face. His prosthetic leg was on the ground beside him.) But… every person you treat generally had a very personal reason to be there. Every single one had to raise $2300 just to walk. The emotional investment is already there and reinforced by a very emotional opening ceremony, cheering stations, media blitz leading up to the event, feelings of obligation to donors… it is very highly emotionally charged.
Resources- Provided and good. Van crews pick up walkers as needed with learned signals. Volunteer nurses have needles to lance blisters, massage tables or cots to put patients on (though in a rush, you treat kneeling on grass with your patient), gauze, bacitracin, moleskin, benzoin spray, hydrogel pads, tape, IV start kits and fluid (hung by bungy cords in the tent). IV’s are only provided at lunch and main camp. Emergency meds and AEDS are also only at lunch stop and main camp. Overseen by MD, but event coverage is on a doctor or nurse practitioner willing to let a group of volunteers work under their license. Individual malpractice insurance is recommended but not required.
Documenation- Very specific event paperwork. CNA’s and techs are assigned to be clerks for paperwork.
Liability- Larger risk with a higher risk group, but generally have some protection under the sponsoring provider’s license and the waivers signed by participants. Also, there are very specific protocols and procedures, and it is possible to stop a walker from continuing by pulling their credentials, and “red carding” them requiring the practitioner re-evaluation to get their certs back. They cannot continue on the route until they can check in with their valid card.
Competitive Sport Endurance (Medieval re-enactment fighter)
Focus- For the participant, winning a war or tourney, usually for a highly emotional reason- personal pride, inspiration of a Lord or Lady, for a household, group, barony or kingdom. Focus for the caregiver- keep them on the field having a good time without injury to self or others. Hugely, non-combat participants are in needs of First Aid services. The challenge is to keep the focus on event specific care as much as possible. Most common injury by far is heat injury both in participant and spectator. Participants tend to be conditioned by training, but there are exceptions to every rule. Following heat injury and dehydration, most commonly seen are abrasions, “armor bites”, contusions, and muscle strain and sprain. Rarely there is a broken bone. With a wide spectrum of spectator, the age range is infant to geriatric. There is call to treat hypoglycemia, migraines, and cardiac symptoms. Most of the latter fall under referral to care outside of the event. The other patient seen at these events is alcohol poisoning.
Resources- No First Aid supplies are given out. Volunteers provide their own kits. There is support staff in the Waterbearers who provide water, sports drinks, pickles, orange slices and pretzels. Additionally, the fighting field safety is monitored by “marshalls”. In a case an individual wishes to continue to compete against your best medical advice, you may appeal to them to deny entry back into the field.
Documentation- Variable by organization. In the Society for Creative Anchron (SCA) - incident report, event report, regional report, which is compiled by the poor unfortunate soul known as the Kingdom Chirurgeon reporting deputy for the Kingdom Chirugeon for Kingdom Curia report and report to the overall group entity, the Society. Yes, this is so much gibberish. So was H&P not too long ago.
Liability- Dependent on the insurance rider of the group. Most groups, as the one I am familiar with, the SCA, limits liability by providing a scope of care limited to First Aid. Once you have stepped beyond the scope provided by the charter, you are on your own risk and liability.
General thoughts:
1. Be flexible. Where you want to be may not be where the greatest need is.
2. Don’t be know-it-all out of the gate. Learn the standards and expectations of the group and organization before you tell them what they’re doing wrong.
3. Be kind. Events are staffed by volunteers that come in three varieties- worth their weight in gold, worth what you paid, and owe you a refund on investment. Regardless, thye are there out of the kindness and good will of their hearts. Give some grace.
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