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Re: [E-Chir] Re: Pennsic XXXV griping

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  • Jackie Wyatt
    ... She probably would- she loves silly latin phrases. ; Apparently the Pennsic Independant wasn t too fun a place to be around either at some
    Message 1 of 16 , Sep 13, 2006
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      > New Mantra for Ealdormerean Chirurgeons: kiss boo-boos. Kiss boo-
      > boos. <grin> I wonder if I can get Nicolaa to translate that into
      > Latin as a Kingdom motto? <grin>

      <snort!> She probably would- she loves silly latin phrases. ;>

      Apparently the Pennsic Independant wasn't too fun a place to be around either at some points as
      well due to the rumours. Nicolaa mentioned that there were some nasty ones going around about
      them withholding information and other such things, which wasn't true at all.

      Medb
      (who wanted to be at Pennsic but had to be at a conference instead)

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    • Claude Gagne
      Hello folks! Having recently suffered an injury at an event myself I can totally appreciate the quality of the chirugeons first hand. So, yes, you rock! I am
      Message 2 of 16 , Sep 13, 2006
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        Hello folks!
         
        Having recently suffered an injury at an event myself I can totally appreciate the quality of the chirugeons first hand. So, yes, you rock!
         
        I am an "unauthorized" chirurgeon, that's to say that I don't have my papers although I trained in the navy (every 2 years we took the damn course) and I've seen some pretty serious stuff in my 20 years with those crazy bast^*&s. Open chest wounds, gunshots, stabbings, broken bones, bruises etc...The point I'm trying to make really is this. It doesn't matter how well trained you are it comes right down to the kind of first aider you are.
         
        We deal with some pretty minor stuff. Small broken bones, heat exhaustion, dehydration, and so on. Not to belittle those but overall, easy to deal with and if treated well not life threating. The most serious problem I saw was Baron Tancred at Pennsic. Here's a man in his 60's suffering an angina attack and while someone faints the EMTs left him to tend to her. Although I can see one of them going to check on her breathing, surely someone should have stayed with him. But they didn't. For almost a minute, Tancred was unattended. So much for training.
         
        Here's the situation as I see it. We need to determine what we are going to do as a Kingdom at our events. I've been to 34 events, counting scolas, in the past 12 months and not once was I aware of the location of first aid except at Pennsic. We need to be more omnipresent. If we don't want to herald it fine. But at least let the Marshall in Charge know who and where you are.
         
        We also need to agree on a standard procedure for injuries suffered on the field or in the list. For example if a fighter gets hurt and pulls himself out because he's hurt, not counting a little cut on his pinky, then he should stay out untill it's deemed safe for him to go back in by a chirurgeon. Now. I'm not saying that we should have the right to stop someone from fighting. But, I'm sure that given an injury of a serious nature we could discuss it with the MIC and have that person withdrawn from the fighting. It's something that I am debating myself because as a fighter I am being a devil's advocate. I've fought when I shouldn't. But, we need to assert a certain common sense that adreline pumped stick jocks seem to lack.
         
        Hoping this will get us chatting in a new direction, (can't change the past) I remain humbly in your service.
         
        Derfel Mallory
      • Streonwold Wulfesbana (mka Steve Benetti)
        ... going to do as a Kingdom at our events. I ve been to 34 events, counting scolas, in the past 12 months and not once was I aware of the location of first
        Message 3 of 16 , Sep 13, 2006
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          --- In E-Chir@yahoogroups.com, Claude Gagne <claude_gagne_tech@...> wrote:
          >snippage
          > Here's the situation as I see it. We need to determine what we are
          going to do as a Kingdom at our events. I've been to 34 events,
          counting scolas, in the past 12 months and not once was I aware of the
          location of first aid except at Pennsic. We need to be more
          omnipresent. If we don't want to herald it fine. But at least let the
          Marshall in Charge know who and where you are.

          This has been discussed at length on the "other" list, too, and the
          concensus there seemed to be either "tell the autocrat and MIC where
          the CIC will be (ie. sitting over there, fencing, fighting, etc.) and
          let people shout for help when they need it" or "put up a banner and
          hang out where people can see you". The problem with the latter
          approach is that people see "the Chirurgeon vulture" waiting for
          badness to happen (and it can be really boring for a Chi that would
          rather be fighting - this is, after all a game that only improves with
          involvement.) The problem with the former approach is that, unless
          you need a Chi, you don't know they're there (or maybe that's not
          really a problem).


          > We also need to agree on a standard procedure for injuries suffered
          on the field or in the list. For example if a fighter gets hurt and
          pulls himself out because he's hurt, not counting a little cut on his
          pinky, then he should stay out untill it's deemed safe for him to go
          back in by a chirurgeon. Now. I'm not saying that we should have the
          right to stop someone from fighting. But, I'm sure that given an
          injury of a serious nature we could discuss it with the MIC and have
          that person withdrawn from the fighting. It's something that I am
          debating myself because as a fighter I am being a devil's advocate.
          I've fought when I shouldn't. But, we need to assert a certain common
          sense that adreline pumped stick jocks seem to lack.

          Typically (for those of us that have practiced at war, anyway) we
          follow the Fighter's Bill of Rights:
          "Society Law prohibits the Chirurgeon from removing a fighter from the
          field against their will. To help fighters and Chirurgeons work better
          together, let me present the "Fighter's Bill of Rights" as written and
          presented at a Chirurgeon's conference at Estrella War by Lady Selena
          D'Ambra in AS XXX, formulated as a statement from the fighter to the
          Chirurgeon:

          If I refuse care and I am oriented and coherent (even if annoyed,
          preoccupied or angry), that is my LEGAL RIGHT.

          It is up to me whether or not I go back to fighting. I am an adult
          with a signed waiver. If you feel I am in danger to other fighters or
          myself, tell a marshal of your concerns. But quietly please, so if
          either of us is wrong, neither of us will be embarrassed.

          If I am injured, ask questions of and listen to me and my friends
          and family. Like me, they also know what is normal for me and how my
          armor goes on and comes off.

          Before you do anything, from slapping a cool cloth on my neck to
          cutting my armor, ask me. Maybe I'll like it, maybe I'll club you like
          a baby harp seal."

          Streonwold
        • Benetti,Sandy [Ontario]
          With respect to the situation with Tancred. The EMTs may not be at fault. It is entirely possible that the only information they had was an individual with
          Message 4 of 16 , Sep 13, 2006
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            Message
            With respect to the situation with Tancred.  The EMTs may not be at fault.  It is entirely possible that the only information they had was "an individual with possible heart related issues". When they arrived, they were directed to a person laying on the street with breathing difficulties. It would be easy for them to assume that this was the person they were called to attend.  It was probably at that point that someone else pointed out that Tancred was the reason they were called not the person on the street. Hence a second ambulance arrived for Tancred.
             
            It may also be a triage situation. You have 2 casualties. The first is on the ground, conscious, with very apparent breathing difficulties. The second is sitting quietly, conscious and appears to be breathing normally. Which do you check first? The one with obvious breathing issues.
             
            Happily in this case there was a very fast response for the arrival of both ambulances, the person on the street was okay ( a close friend of Tancred's who reacted badly to Tancred's initial resistance to going in the ambulance) and Tancred, who was back on site the next day and attended the Ealdormere Bardic circle.
             
             
            As to the rest of your suggestions:
             
            I like the idea of having a more visible/obvious presence for first aid (even if it's just a sign at troll that says who the chirurgeon for the event is or where one can go for first aid issues)
             
            I'm not so sure about the "pulling someone from fighting" part.
            We can offer assistance, we can suggest that someone stop fighting if we think it's warranted due to the nature of the injury. We can't make them stop as you pointed out. The MIC can't make them stop either unless they present a danger to the other fighters. Oddly I don't believe there's anything that covers "danger to yourself" in this situation. One would hope, that if the injury were of a serious nature that no convincing would be necessary.
             
            This brings us to the "how do you determine it's serious"?  It's not always obvious.  If I may Derfel, let me use your situation as an example.  If you had come to me with the injury or if I had seen the incident which caused it and asked to check you over I would have suspected a sprain (at the very least)  and suggested you quit fighting for the day and if the pain persisted that you get it checked by a doctor in case it was more serious. I imagine a couple of people may have done that and you probably said, "hey it's no big deal it's just a minor sprain."  As it turned out, it was more serious than just a minor sprain.  So, where do you draw the line? How far do you go?  Do you talk to the MIC and say "this person has a bad sprain, I don't think they should fight anymore but they want to keep going, will you pull them from the fighting on the grounds that they could make it worse"?    Probably not. Do You try to scare the fighter into doing what you want by predicting dire things if they aggravate the injury? Probably not.  All you can do is encourage them to at least take a break because running around with even an minor sprain can aggravate the injury and prolong the time it takes to heal it. 
             
            It's a fine line between doing the best for the person you are trying to look after and being a "cowboy" and running roughshod over them when a bit of diplomacy and gentle persuasion is all that's needed.  It's not something you can regulate or make a manual for. Every situation is different.  Now if the fighter pulls himself out, it may be a good idea to go to the Chirurgeon and tell that person the reason so that the Chirurgeon can keep an eye on them or offer first aid.  Hopefully the fighter will consult the Chirurgeon before trying to resume fighting but if they don't, there isn't a lot we can do to prevent it. We're all adults and unless there is an obvious risk of danger to other people (again I'm not sure there's anything in the rules about being a danger to yourself) it would be very difficult to pull the person out against their wishes.
             
            Having said all of that, I have found that most of our fighters are pretty reasonable and they also have a pretty good idea of their limits. I have only had one or two occasions where I've suggested that the individual hang it up for the day. Once for heat related stuff and once for a knee pull.  Both times the fighter, went back in to try one more round and both times, they came out almost immediately following the first swing and said "nope your right, I need to stop now". It was getting the one with the knee to sit quietly and rest the knee that was the hard part.
             
            Seonag
             
            -----Original Message-----
            From: E-Chir@yahoogroups.com [mailto:E-Chir@yahoogroups.com] On Behalf Of Claude Gagne
            Sent: September 13, 2006 8:53 AM
            To: E-Chir@yahoogroups.com
            Subject: Re: [E-Chir] Re: Pennsic XXXV griping

            Hello folks!
             
            Having recently suffered an injury at an event myself I can totally appreciate the quality of the chirugeons first hand. So, yes, you rock!
             
            I am an "unauthorized" chirurgeon, that's to say that I don't have my papers although I trained in the navy (every 2 years we took the damn course) and I've seen some pretty serious stuff in my 20 years with those crazy bast^*&s. Open chest wounds, gunshots, stabbings, broken bones, bruises etc...The point I'm trying to make really is this. It doesn't matter how well trained you are it comes right down to the kind of first aider you are.
             
            We deal with some pretty minor stuff. Small broken bones, heat exhaustion, dehydration, and so on. Not to belittle those but overall, easy to deal with and if treated well not life threating. The most serious problem I saw was Baron Tancred at Pennsic. Here's a man in his 60's suffering an angina attack and while someone faints the EMTs left him to tend to her. Although I can see one of them going to check on her breathing, surely someone should have stayed with him. But they didn't. For almost a minute, Tancred was unattended. So much for training.
             
            Here's the situation as I see it. We need to determine what we are going to do as a Kingdom at our events. I've been to 34 events, counting scolas, in the past 12 months and not once was I aware of the location of first aid except at Pennsic. We need to be more omnipresent. If we don't want to herald it fine. But at least let the Marshall in Charge know who and where you are.
             
            We also need to agree on a standard procedure for injuries suffered on the field or in the list. For example if a fighter gets hurt and pulls himself out because he's hurt, not counting a little cut on his pinky, then he should stay out untill it's deemed safe for him to go back in by a chirurgeon. Now. I'm not saying that we should have the right to stop someone from fighting. But, I'm sure that given an injury of a serious nature we could discuss it with the MIC and have that person withdrawn from the fighting. It's something that I am debating myself because as a fighter I am being a devil's advocate. I've fought when I shouldn't. But, we need to assert a certain common sense that adreline pumped stick jocks seem to lack.
             
            Hoping this will get us chatting in a new direction, (can't change the past) I remain humbly in your service.
             
            Derfel Mallory

          • KIM MCAULEY
            Actually I can speak to that situation as I was attending as a first aider. And I should mention Tancred gave me specific permission to speak to other
            Message 5 of 16 , Sep 13, 2006
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              Actually I can speak to that situation as I was attending as a first aider. And I should mention Tancred gave me specific permission to speak to other chirurgeons, and he was discussing the incident publically, so we are not breaking any confidentiality here. But please keep this among ourselves.
               
              I escorted the first ambulance to Patient 1. When I arrived, he was being attended by at least one other chirurgeon. He refused care from EMS quite emphatically and repeatedly, in fact their presence was agitating him. I asked EMS to wait outside while he calmed down and was persuaded to allow their assistance.
               
              While they were waiting outside, Patient 2 became unresponsive. Having been refused at the first patient, they attended at the second and immediately called for a second EMS unit to attend Patient 1 when he was ready.
               
              My first aid training says that responsiveness is right up there with ABC and should be treated just as seriously, but your and their mileage may vary.
               
              Sometimes s***tuff just happens in great leaps and bounds. One deals with it the best they can.
               
              Kaellyn
               
               


               
              ----- Original Message ----
              We deal with some pretty minor stuff. Small broken bones, heat exhaustion, dehydration, and so on. Not to belittle those but overall, easy to deal with and if treated well not life threating. The most serious problem I saw was Baron Tancred at Pennsic. Here's a man in his 60's suffering an angina attack and while someone faints the EMTs left him to tend to her. Although I can see one of them going to check on her breathing, surely someone should have stayed with him. But they didn't. For almost a minute, Tancred was unattended. So much for training.
               
            • Claude Gagne
              Thank you for clearing that up for me. Standing outside the tent seemed a different story altogether. Well done. Derfel ... From: KIM MCAULEY
              Message 6 of 16 , Sep 13, 2006
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                Thank you for clearing that up for me.
                 
                Standing outside the tent seemed a different story altogether.
                 
                Well done.
                 
                Derfel

                ----- Original Message ----
                From: KIM MCAULEY <viscountessk@...>
                To: E-Chir@yahoogroups.com
                Sent: Wednesday, September 13, 2006 11:00:48 AM
                Subject: Re: [E-Chir] Re: Pennsic XXXV griping

                Actually I can speak to that situation as I was attending as a first aider. And I should mention Tancred gave me specific permission to speak to other chirurgeons, and he was discussing the incident publically, so we are not breaking any confidentiality here. But please keep this among ourselves.
                 
                I escorted the first ambulance to Patient 1. When I arrived, he was being attended by at least one other chirurgeon. He refused care from EMS quite emphatically and repeatedly, in fact their presence was agitating him. I asked EMS to wait outside while he calmed down and was persuaded to allow their assistance.
                 
                While they were waiting outside, Patient 2 became unresponsive. Having been refused at the first patient, they attended at the second and immediately called for a second EMS unit to attend Patient 1 when he was ready.
                 
                My first aid training says that responsiveness is right up there with ABC and should be treated just as seriously, but your and their mileage may vary.
                 
                Sometimes s***tuff just happens in great leaps and bounds. One deals with it the best they can.
                 
                Kaellyn
                 
                 


                 
                ----- Original Message ----
                We deal with some pretty minor stuff. Small broken bones, heat exhaustion, dehydration, and so on. Not to belittle those but overall, easy to deal with and if treated well not life threating. The most serious problem I saw was Baron Tancred at Pennsic. Here's a man in his 60's suffering an angina attack and while someone faints the EMTs left him to tend to her. Although I can see one of them going to check on her breathing, surely someone should have stayed with him. But they didn't. For almost a minute, Tancred was unattended. So much for training.
                 

              • Kim
                It just goes to show that sometimes we don t have all the information. Asking is the best way to find out, and if we can share without breaking
                Message 7 of 16 , Sep 13, 2006
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                  It just goes to show that sometimes we don't have all the information. Asking is the best way to find out, and if we can share without breaking confidentiality, we all learn.
                   
                  Kaellyn
                   
                  ----- Original Message -----
                  Sent: Wednesday, September 13, 2006 2:35 PM
                  Subject: Re: [E-Chir] Re: Pennsic XXXV griping

                  Thank you for clearing that up for me.
                   
                  Standing outside the tent seemed a different story altogether.
                   
                  Well done.
                   
                  Derfel

                  ----- Original Message ----
                  From: KIM MCAULEY <viscountessk@...>
                  To: E-Chir@yahoogroups.com
                  Sent: Wednesday, September 13, 2006 11:00:48 AM
                  Subject: Re: [E-Chir] Re: Pennsic XXXV griping

                  Actually I can speak to that situation as I was attending as a first aider. And I should mention Tancred gave me specific permission to speak to other chirurgeons, and he was discussing the incident publically, so we are not breaking any confidentiality here. But please keep this among ourselves.
                   
                  I escorted the first ambulance to Patient 1. When I arrived, he was being attended by at least one other chirurgeon. He refused care from EMS quite emphatically and repeatedly, in fact their presence was agitating him. I asked EMS to wait outside while he calmed down and was persuaded to allow their assistance.
                   
                  While they were waiting outside, Patient 2 became unresponsive. Having been refused at the first patient, they attended at the second and immediately called for a second EMS unit to attend Patient 1 when he was ready.
                   
                  My first aid training says that responsiveness is right up there with ABC and should be treated just as seriously, but your and their mileage may vary.
                   
                  Sometimes s***tuff just happens in great leaps and bounds. One deals with it the best they can.
                   
                  Kaellyn
                   
                   


                   
                  ----- Original Message ----
                  We deal with some pretty minor stuff. Small broken bones, heat exhaustion, dehydration, and so on. Not to belittle those but overall, easy to deal with and if treated well not life threating. The most serious problem I saw was Baron Tancred at Pennsic. Here's a man in his 60's suffering an angina attack and while someone faints the EMTs left him to tend to her. Although I can see one of them going to check on her breathing, surely someone should have stayed with him. But they didn't. For almost a minute, Tancred was unattended. So much for training.
                   

                • Kim
                  MessageI ve discovered something very important over the years. Goodness knows that old age had to bring something besides grey hairs. Cultivate a reputation
                  Message 8 of 16 , Sep 13, 2006
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                    Message
                    I've discovered something very important over the years. Goodness knows that old age had to bring something besides grey hairs.
                     
                    Cultivate a reputation for being a reasonable, "yes, sure, go on if you want, I've warned you" kind of person, then when you do recommend something like sitting out or seeking medical attention immediately, they're more likely to listen.
                     
                    Manipulating fighters and other ... nvm? Hey, I'm Collin's mom. I'm an expert!
                     
                    ;)
                     
                    Kaellyn
                     
                    ----- Original Message -----
                    Sent: Wednesday, September 13, 2006 9:29 AM
                    Subject: RE: [E-Chir] Re: Pennsic XXXV griping

                    With respect to the situation with Tancred.  The EMTs may not be at fault.  It is entirely possible that the only information they had was "an individual with possible heart related issues". When they arrived, they were directed to a person laying on the street with breathing difficulties. It would be easy for them to assume that this was the person they were called to attend.  It was probably at that point that someone else pointed out that Tancred was the reason they were called not the person on the street. Hence a second ambulance arrived for Tancred.
                     
                    It may also be a triage situation. You have 2 casualties. The first is on the ground, conscious, with very apparent breathing difficulties. The second is sitting quietly, conscious and appears to be breathing normally. Which do you check first? The one with obvious breathing issues.
                     
                    Happily in this case there was a very fast response for the arrival of both ambulances, the person on the street was okay ( a close friend of Tancred's who reacted badly to Tancred's initial resistance to going in the ambulance) and Tancred, who was back on site the next day and attended the Ealdormere Bardic circle.
                     
                     
                    As to the rest of your suggestions:
                     
                    I like the idea of having a more visible/obvious presence for first aid (even if it's just a sign at troll that says who the chirurgeon for the event is or where one can go for first aid issues)
                     
                    I'm not so sure about the "pulling someone from fighting" part.
                    We can offer assistance, we can suggest that someone stop fighting if we think it's warranted due to the nature of the injury. We can't make them stop as you pointed out. The MIC can't make them stop either unless they present a danger to the other fighters. Oddly I don't believe there's anything that covers "danger to yourself" in this situation. One would hope, that if the injury were of a serious nature that no convincing would be necessary.
                     
                    This brings us to the "how do you determine it's serious"?  It's not always obvious.  If I may Derfel, let me use your situation as an example.  If you had come to me with the injury or if I had seen the incident which caused it and asked to check you over I would have suspected a sprain (at the very least)  and suggested you quit fighting for the day and if the pain persisted that you get it checked by a doctor in case it was more serious. I imagine a couple of people may have done that and you probably said, "hey it's no big deal it's just a minor sprain."  As it turned out, it was more serious than just a minor sprain.  So, where do you draw the line? How far do you go?  Do you talk to the MIC and say "this person has a bad sprain, I don't think they should fight anymore but they want to keep going, will you pull them from the fighting on the grounds that they could make it worse"?    Probably not. Do You try to scare the fighter into doing what you want by predicting dire things if they aggravate the injury? Probably not.  All you can do is encourage them to at least take a break because running around with even an minor sprain can aggravate the injury and prolong the time it takes to heal it. 
                     
                    It's a fine line between doing the best for the person you are trying to look after and being a "cowboy" and running roughshod over them when a bit of diplomacy and gentle persuasion is all that's needed.  It's not something you can regulate or make a manual for. Every situation is different.  Now if the fighter pulls himself out, it may be a good idea to go to the Chirurgeon and tell that person the reason so that the Chirurgeon can keep an eye on them or offer first aid.  Hopefully the fighter will consult the Chirurgeon before trying to resume fighting but if they don't, there isn't a lot we can do to prevent it. We're all adults and unless there is an obvious risk of danger to other people (again I'm not sure there's anything in the rules about being a danger to yourself) it would be very difficult to pull the person out against their wishes.
                     
                    Having said all of that, I have found that most of our fighters are pretty reasonable and they also have a pretty good idea of their limits. I have only had one or two occasions where I've suggested that the individual hang it up for the day. Once for heat related stuff and once for a knee pull.  Both times the fighter, went back in to try one more round and both times, they came out almost immediately following the first swing and said "nope your right, I need to stop now". It was getting the one with the knee to sit quietly and rest the knee that was the hard part.
                     
                    Seonag
                     
                  • Claude Gagne
                    I m replying to 2 e-mails at once so bear with me please. 1. It just goes to show that sometimes we don t have all the information. Asking is the best way to
                    Message 9 of 16 , Sep 13, 2006
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                      I'm replying to 2 e-mails at once so bear with me please.
                       
                      1. It just goes to show that sometimes we don't have all the information. Asking is the best way to find out, and if we can share without breaking confidentiality, we all learn.
                       
                      Kaellyn
                       Yes. And thanks again for the help. I'm never beyond admitting I was wrong.
                       
                      2. I've discovered something very important over the years. Goodness knows that old age had to bring something besides grey hairs.

                       

                      Kaellyn
                      Do you mean that the grey hairs on my head serve as more than a reminder of all my mistakes. Ouch! That's quite a few.
                       
                      Looking forward to meeting you in person, I remain humbly yours.
                       
                      Derfel

                       
                      ----- Original Message ----
                      From: Kim <viscountessk@...>
                      To: E-Chir@yahoogroups.com
                      Sent: Wednesday, September 13, 2006 5:09:40 PM
                      Subject: Re: [E-Chir] Re: Pennsic XXXV griping

                      I've discovered something very important over the years. Goodness knows that old age had to bring something besides grey hairs.
                       
                      Cultivate a reputation for being a reasonable, "yes, sure, go on if you want, I've warned you" kind of person, then when you do recommend something like sitting out or seeking medical attention immediately, they're more likely to listen.
                       
                      Manipulating fighters and other ... nvm? Hey, I'm Collin's mom. I'm an expert!
                       
                      ;)
                       
                      Kaellyn
                       
                      ----- Original Message -----
                      Sent: Wednesday, September 13, 2006 9:29 AM
                      Subject: RE: [E-Chir] Re: Pennsic XXXV griping

                      With respect to the situation with Tancred.  The EMTs may not be at fault.  It is entirely possible that the only information they had was "an individual with possible heart related issues". When they arrived, they were directed to a person laying on the street with breathing difficulties. It would be easy for them to assume that this was the person they were called to attend.  It was probably at that point that someone else pointed out that Tancred was the reason they were called not the person on the street. Hence a second ambulance arrived for Tancred.
                       
                      It may also be a triage situation. You have 2 casualties. The first is on the ground, conscious, with very apparent breathing difficulties. The second is sitting quietly, conscious and appears to be breathing normally. Which do you check first? The one with obvious breathing issues.
                       
                      Happily in this case there was a very fast response for the arrival of both ambulances, the person on the street was okay ( a close friend of Tancred's who reacted badly to Tancred's initial resistance to going in the ambulance) and Tancred, who was back on site the next day and attended the Ealdormere Bardic circle.
                       
                       
                      As to the rest of your suggestions:
                       
                      I like the idea of having a more visible/obvious presence for first aid (even if it's just a sign at troll that says who the chirurgeon for the event is or where one can go for first aid issues)
                       
                      I'm not so sure about the "pulling someone from fighting" part.
                      We can offer assistance, we can suggest that someone stop fighting if we think it's warranted due to the nature of the injury. We can't make them stop as you pointed out. The MIC can't make them stop either unless they present a danger to the other fighters. Oddly I don't believe there's anything that covers "danger to yourself" in this situation. One would hope, that if the injury were of a serious nature that no convincing would be necessary.
                       
                      This brings us to the "how do you determine it's serious"?  It's not always obvious.  If I may Derfel, let me use your situation as an example.  If you had come to me with the injury or if I had seen the incident which caused it and asked to check you over I would have suspected a sprain (at the very least)  and suggested you quit fighting for the day and if the pain persisted that you get it checked by a doctor in case it was more serious. I imagine a couple of people may have done that and you probably said, "hey it's no big deal it's just a minor sprain."  As it turned out, it was more serious than just a minor sprain.  So, where do you draw the line? How far do you go?  Do you talk to the MIC and say "this person has a bad sprain, I don't think they should fight anymore but they want to keep going, will you pull them from the fighting on the grounds that they could make it worse"?    Probably not. Do You try to scare the fighter into doing what you want by predicting dire things if they aggravate the injury? Probably not.  All you can do is encourage them to at least take a break because running around with even an minor sprain can aggravate the injury and prolong the time it takes to heal it. 
                       
                      It's a fine line between doing the best for the person you are trying to look after and being a "cowboy" and running roughshod over them when a bit of diplomacy and gentle persuasion is all that's needed.  It's not something you can regulate or make a manual for. Every situation is different.  Now if the fighter pulls himself out, it may be a good idea to go to the Chirurgeon and tell that person the reason so that the Chirurgeon can keep an eye on them or offer first aid.  Hopefully the fighter will consult the Chirurgeon before trying to resume fighting but if they don't, there isn't a lot we can do to prevent it. We're all adults and unless there is an obvious risk of danger to other people (again I'm not sure there's anything in the rules about being a danger to yourself) it would be very difficult to pull the person out against their wishes.
                       
                      Having said all of that, I have found that most of our fighters are pretty reasonable and they also have a pretty good idea of their limits. I have only had one or two occasions where I've suggested that the individual hang it up for the day. Once for heat related stuff and once for a knee pull.  Both times the fighter, went back in to try one more round and both times, they came out almost immediately following the first swing and said "nope your right, I need to stop now". It was getting the one with the knee to sit quietly and rest the knee that was the hard part.
                       
                      Seonag
                       

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