The lifeboat volunteer, a teacher himself, wasn’t happy: ‘Nothing makes me more cross than giving up my time and having to suffer bad teaching. Now we’re to be guinea pigs for some new first aid training …’

In 2007, John Gilmour discovered that this course was different: ‘It was the most interesting and knowledge-enriching course I have ever undertaken.’ Now hundreds of his fellows have completed the new training and all will have been trained by mid-2011.

From 2002 to 2006, RNLI lifeboats launched to around 3,000 services with a medical component, from illness to injury, to exposure and drowning. Over 3,300 people were directly treated by RNLI volunteers but in 85% of cases these volunteers were not medical professionals. How could they be confident that they were making the correct diagnosis and giving correct treatment?

A unique approach

When Paul Savage joined the RNLI in 2005 as Sea Survival and First Aid Trainer, he knew it would be difficult to cater for the disparate abilities of over 4,000 crew members and lifeguards. However, as a former volunteer crew member himself, a former paramedic and a chartered physiotherapist, Paul was well placed to review the RNLI’s approach to first aid.

He consulted with experts in prehospital care, other search and rescue (SAR) organisations and the military to find what was current best practice. Then, by studying the RNLI’s medical service data, he was able to identify and prioritise the subject matter essential for lifeboat crews.

Their unique environment rarely allows a safe and stable platform on which to give treatment. This necessitates difficult transfers of rescuers and casualties between boats or to dry land. The weight of equipment that crew can carry is limited and they work far from specialist support.

Paul decided on a radical change. Instead of a traditional syllabus, based on diagnosis, he devised one based on what a crew member sees and therefore knows – a symptom-based approach.

Theory and practice

The new course is 75% practical. Swanage volunteer John enthuses: ‘We’re being asked to decide if someone is “big sick” or “little sick”. It’s simple: “big sick” equals going to die soon of no oxygen or no circulation while “little sick” equals not going to die – just yet! And then we do whatever we can to prevent things from getting worse.’

The new course caters for all learning styles. John adds: ‘I suspect that’s why we got so much from it. None of us got bored – we were enjoying ourselves and learning quickly.’ At the core of the course are a set of acronyms and a pack of waterproof check cards (below).

Employing flow charts rather than heavy text, the cards cover aspects of injury, illness and immersion, and even triage for when casualties outnumber first aiders. Trainees learn to determine whether the casualty requires rapid evacuation for professional medical assistance (big sick) or is less critical and can be transferred by lifeboat with first aid support onboard (little sick). They rapidly gain confidence that their decisions are correct.

Kilrush inshore lifeboat crew tried the approach on 13 August 2008 in their rescue of an injured yachtsman. They recorded the notes shown below left.

Yves Borrel, also onboard the yacht, later wrote: ‘Our friend was transferred to a specialised hospital in Caen. He suffered a double fracture of the skull leading to some deafness in his left ear and … his rehabilitation will take between 6–12 months. We sincerely thank you and your colleagues for your intervention and effective care of our wounded friend.’

Even ashore the training comes easily into play as Exmouth Crew Member David Preece recounts: ‘My first aid was put into practice after an elderly lady fell and hurt her back and face. I was straight into DR(C)ABCDE as I had my check cards in my pocket – result! When handing her over to the ambulance, the crew thought the cards were great.’

Approval and accreditation

Following a second pilot in early 2008, members of the RNLI’s Medical and Survival Sub-Committee, the body responsible for the charity’s clinical governance, undertook the course themselves. Specialists in resuscitation, orthopaedics, cardiology, cold-water shock and more, they gave their final approval and accreditation, allowing the RNLI to produce a course to its own requirements and maintain its own quality assurance.

To gain the new RNLI First Aid for Lifeboat Crews qualification, which is valid for 3 years, crew must carry out over 30 DR(C)ABCDE assessments, answer two multiple-choice papers and demonstrate competence in practical scenarios. The course also provides a qualification accredited by the UK Maritime and Coastguard Agency (MCA).

Lifeboat crews are trained either at their station, in eight 2½-hour sessions via a team of Mobile Training Unit (MTU) trainers, or at the Lifeboat College as part of a 4½-day Sea Survival course (sponsored by Lloyd’s Register Educational Trust).

The British Paramedic Association (BPA), the Paramedic Science Degree course at the University of Hertfordshire, and the Anaesthesia, Trauma and Critical Care (ATACC) group have all approved the course and all 15 UK Ambulance Trusts and the RoI’s National Ambulance Service have had the opportunity to review it.

Recognition has also come from the UK SAR Operators Medical Group. The RNLI qualification meets Level 3 competence, above first responder and below medical technician and paramedic.

Dr Mark Forrest, Medical Director at ATACC, says: ‘You should be congratulated for leading the way … many other emergency organisations will attempt to follow.’ Ambulance Service have had the opportunity to review it.

Recognition has also come from the UK SAR Operators Medical Group. The RNLI qualification meets Level 3 competence, above first responder and below medical technician and paramedic. Dr Mark Forrest, Medical Director at ATACC, says: ‘You should be congratulated for leading the way … many other emergency organisations will attempt to follow.’

Adapting and developing

The RNLI’s next task was to adapt the course to suit the needs of RNLI lifeguards – and all 750+ lifeguards have just been trained in three 2-week blocks.

They followed essentially the lifeboat course but swapped treatment of seasickness for stings. An extra 4 hours covered the automatic external defibrillator, spinal management, dressing of minor injuries and dealing with observers. Returning lifeguards will receive an annual refresher before the season starts.

To complete the specialist training, a course for the RNLI Flood Rescue team has alsoeen run at the College.

Modernised equipment items include haemorrhage dressings, tourniquets, a disposable bag valve mask and suction, triage labels, shoulder bags and more effective blankets. The course has also adopted a first aid reference book produced by the BPA, Emergency Care and Safety Institute and College of Paramedics with an RNLI-specific chapter.

Costs of training are high but savings on resources have been enormous. Equipment is now standard across all operational areas, saving on storage and opening doors to bulk discounts. And by accrediting its own qualification, the RNLI saves on external certification and training materials.

Difficult odds

Qualified first aiders give casualties a better chance of survival but it may still be slim.

Trainer Rob Smith had just finished a session with Aldeburgh crew when they came across a road traffic accident. They gave first aid including cardiopulmonary resuscitation (CPR) to a seriously injured woman. They later heard that she had died, but the CPR had ensured that her organs could be donated.

Alan Pattinson feels he was ‘really, really lucky’ last year: ‘I collapsed in a beach car park with people that were astute enough to know that I wasn’t sunbathing, I was ill.’ Lifeguard Jonny Hanley reflects: ‘Only 2 weeks before, I was on my induction with the Penwith lifeguards and we were working on the same sort of scenarios. Alan’s here today thanks to the training and equipment.’

What’s next?

After a recent station medical exercise, John Gilmour remarked: ‘It's all come flooding back. Now all I need to do is stop it all flooding out again!’ To keep skill fade to a minimum the RNLI is looking at standardising medical exercises.

Whitstable station has held an annual first aid competition since 1977 and Lifeboat Medical Adviser Dr Terry Stefani says: ‘You don’t need many props to create difficult scenarios! The course has turned conventional treatment on its head and the new kit is first class. It’s enabling crews to be so much more in tune with ambulance crews too.’

Crews and lifeguards can also look forward to downloading information, quizzes and self-assessment modules from the College’s distance learning website.

A proud tradition

The care of survivors after rescue has been a priority for the RNLI since at least 1864 when The Life-boat reported that the Institution issued its stations with a new code of rules in accordance with Dr Marshall Hall’s system of ‘restoring and treating persons apparently drowned’. Now, once again, the RNLI has revolutionised the practice and teaching of first aid in the charity – and beyond.