US National Ski Patrol - European Division

*** HOT TOPICS *** (temporary items that expire)

Local Patrol Level OEC OTH Training - is NOT a replacement/substitute for Region Sponsored On-The-Hill (OTH) training but is viewed as supplemental.

1. The following are some instances where local patrol OEC training and/or validations could be warranted:

• Training - When Region sponsored OTH OEC training needs to be supplemented outside of OTH. The OEC reports should indicate that the candidate would benefit from supplemental training at the local patrol level. Any supplemental training is coordinated by the local Patrol Director and the patrol's OEC staff. Realistic OEC training is more beneficial outdoors and in the snow. Again, this scenario is dealt with at the discretion of the local Patrol Director.

• Validations - When circumstances do not allow the candidate to attend a sanctioned OTH validation event. An example of this might be a member tasked with a short notice deployment. Arrangements are made by the local Patrol Director, in conjunction with the local Patrol OEC staff to schedule the appropriate OEC validation cadre.

2. To the greatest extent possible, OEC validation evaluators will come from different patrols to preclude any perceptions of favoritism/impropriety. Evaluators must be current OEC instructors.

3. In all cases, close coordination with the Region OEC administrator is required and if necessary the Division OEC Supervisor.

Cycle B Year-2009 OEC Refresher document(s) is/are available for download below:

• Refresher Study Guide (3.61 Mb, includes the "You Are The Rescuer" section)

Download and print the document(s) and bring them to the OEC refresher event you choose to attend.

NOTE: With the Division-sponsored OEC Refresher schedule complete, any members not currently refreshed MUST do so ASAP through their local Patrol Director. The Division OEC Supervisor and/or the applicable Region OEC Administrator (above) must coordinate on all Local Patrol level OEC refreshers as the IT of Record for the Course Completion Record.

Permanent Topics (no expiration)

Join the European Division OEC Instructor Group here via Yahoo.

• Items you need to bring to any OEC Refresher:

• • OEC technician card - for signature by the Instructor of Record

• • Fully stocked OEC pack/aid belt - for any hand-ons modules and/or scenario work

• • CPR shield/mask - if you need to refresh CPR for the Professional Rescuer (based on instructor availability)

• • Division Ausweis (ID Credential Trifold) - (if you have one to get the yearly update stamp) - You can get one at each Division sponsored refresher event and at any time thereafter. See the Credentials Administrator's page for details on how to get a Division Ausweis.

Effective 1 August 2009 - OEC Instructor Of Record (IOR) - *** Registering an OEC course and processing the OEC Course Fees *** - The one-time course enrollment fee ($60.00 for NSP members, $50.00 for Affiliates/Associates and $300.00 for non-members) is charged for each OEC student enrolled (regardless of pass, fail or incomplete). This fee is collected (mostly likely by the OEC course IOR) and is indicated on the appropriate line item (#558, #558-1 or #560) on the OEC Course Order Form.

The Process is:

1. The Instructor of Record (IOR) goes to the National Website and signs on via the Member Services page.

2. Down the left side navigation ladder, under the Education Tools header, click on the Register a Course link.

3. Select Outdoor Emergency Care from the "Course Type" drop down list.

4. Fill out the rest of the Course Registration Form.

5. Select send Course Completion Records by "EMAIL".

NOTE: Extend the course End Date well beyond the anticipated course completion date. This will give the IOR a processing cushion and allows for any potential delays that may occur in closing out the course. The National "Late Course" clock will not start until the extended end date has passed.

6. When National sends the IOR a course confirmation email, the IOR completes the OEC Course Order Form. It is used by the IOR to order OEC course materials. The IOR sends either a personal check or a Patrol Treasury check along with this form to the National Office.

• Example: 5 students register as candidates in your patrol. $300.00 is collected (5 X $60.00) for OEC course fees. $300.00 is sent by check to the National Office.

7. Course Completion Roster (CCR) - The IOR must list ALL students enrolled. The IOR indicates, for each student, their pass, fail, or incomplete course status. All CCRs, regardless of discipline, are sent to the Division Registrar for Division database processing. The Registrar will forward CCRs to the National office.

NOTE: The number of students on the CCR must match the total dollar amount of the OEC course fees collected from each student indicated on the original OEC Course Order Form.

• The National Office will not process any OEC CCR without first processing the OEC course fee payment.

9 Sep 2008 - CPR Update

To: All OEC Instructors, OEC Instructor Trainers & OEC Supervisors

From: Larry Bost, Education Committee Chair

There have been some major changes in CPR this year and as always some major confusion. The chart below provides an “at-a-glance” look at the current CPR guidelines for healthcare providers (as presented by the American Heart Association) as well as the NSP policy regarding NSP-approved CPR providers. I asked NSP medical advisor Michael Millin, MD and OEC program director, Ed McNamara to look at these changes and to prepare a informational report on how these changes will affect Patrollers. Dr. Millin's response is below. I would like to thank Dr. Millin and Ed McNamara for their quick response to this question.

Dr. Millin’s Analysis

This is actually an interesting question that is filled with controversy and quite a bit of active research.

The short answer to your question is that the current recommendation is that CPR preformed by a trained healthcare provider (including OEC technicians) should include both chest compressions and rescue breaths in a ratio of 30 compressions to 2 breaths. The long answer is a bit more complex, so please bear with me. For many years it has been believed that the keys to survival from sudden cardiac arrest are chest compressions and defibrillation. The primary initial rhythm in sudden cardiac arrest is typically ventricular fibrillation, which is best treated with electrical defibrillation. The purpose of chest compressions is to circulate blood to the cardiac muscle.

Despite years of community programs to get bystanders to perform chest compressions, there are still low percentages of sudden cardiac arrest patients that get bystander CPR. It is believed that one reason for low bystander CPR is fear of doing mouth-to-mouth rescue breathing. Therefore, researchers have examined the question of survivability if CPR is performed by the lay public with only chest compressions. These studies have clearly shown that when performed by the lay public compression only CPR is just as effective as standard CPR with compressions and rescue breathing. It is this research that has evolved to the most recent recommendation by the American Heart Association (AHA). It is important to understand that the above mentioned research has all been examining CPR in the hands of the lay public. At this point in time, the medical literature is not able to answer the question of standard CPR vs. compression only CPR when performed by a skilled healthcare worker. This is why the recommendation for trained healthcare providers is to continue with standard CPR.

If you are ever truly faced with doing CPR in your capacity as an OEC technician you will notice that CPR is hard work. You will break ribs on your patient, and after 2 minutes of pushing hard, pushing fast, you will be exhausted. While I have seen the value of chest compressions in my own clinical practice, this is supported in the literature as well. The most notable recent study was published by Wik, et al. that demonstrated for those patients with a down time greater than 5 minutes, chest compressions before defibrillation were more successful that just defibrillation. The bottom line is that the current literature supports compression only CPR when performed by the lay public and standard CPR when performed by a skilled healthcare worker. When performing CPR, Push Hard and Push Fast for 30 compressions then perform 2 rescue breaths. Do five cycles and then using an AED, defibrillate if indicated. After defibrillation immediately Push Hard and Push Fast. Do not check for a pulse. Frequently rotate the rescuer doing the chest compressions to minimize fatigue and degradation of the quality of the compressions. Finally, the coordination of doing CPR and getting the patient out of the environment can be quite complex. Exactly how you do this is up to your area. You should look to your local medical advisors, patrol leadership, and area management for direction. The fact is that you may have to stop chest compressions in order to get the patient off the side of a mountain. This is not ideal, but it is reality. If you do have to stop chest compressions, your area should develop a protocol that utilizes resources to as much as possible minimize the time that the patient is without CPR. The reason that this should be an issue of local direction is that the best way to minimize time without CPR will be dependent on the local resources and the topography of the area. I will say that at my local hill we have developed a protocol whereby two patrollers take the patient down in a toboggan. Other patrollers are then strategically placed at about 30 second intervals to perform CPR along the route to the base of the mountain.

While we have not had an actual case yet with this new protocol, we have practiced it many times and it seems to work well. Regardless, every area is different so every area should develop a system before the event that works for the local area. The key is to have a protocol in place that works before the actual event. In addition, I can’t stress enough that regardless of the details of your area’s protocol, it should not put OEC technicians at harm. Your plan should not put OEC technicians (or the public for that matter) at harm for the purpose of trying to save the life of a dead person that has a low chance of survival. Just so that we are clear one more time: 30 compressions with 2 breaths – Push Hard, Push Fast.

- Michael G Millin, MD, MPH, FACEP, NSP National Medical Advisor

Current CPR Guidelines (for healthcare providers)

Maneuver	Adult: 8 years and older	Child: 1 to 8 years	Infant: Under 1 year
Activate	Activate / call for AED when victim found unresponsive If asphyxial arrest likely, call after 5 cycles (2 minutes) of CPR	Activate after performing 5 cycles of CPR For sudden, witnessed collapse, activate after verifying that victim unresponsive
Airway	Head tilt-chin lift (suspected trauma; use jaw thrust)
Breaths Breath check < 10 secs)	2 breaths at 1 second/breath	2 effective breaths at 1 second/breath
Rescue breathing without chest compressions	10-12 breaths/min (approximately 1 breath every 5-6 seconds)	12-20 breaths/min (approximately 1 breath every 3-5 seconds)
Rescue breaths for CPR with advanced airway	8-10 breaths/min (approximately 1 breath every 6-8 seconds)
Foreign-body airway obstruction	Abdominal thrusts		Back slaps and chest thrusts
Circulation Pulse check (< 10 secs)	Carotid (can use femoral in child)		Brachial or femoral
Compression landmarks	Center of chest, between nipples		Just below nipple line
Compression method: Push hard and fast Allow complete recoil	2 Hands: Heel of 1 hand, other hand on top	2 Hands: Heel of 1 hand, with second on top, or, 1 Hand: Heel of 1hand only	1 rescuer: 2 fingers 2 rescuers: 2 thumb-encircling hands
Compression depth	1 ½ - 2 inches	About 1/3 – ½ the Depth of the chest
Compression rate	About 100/min.
Compression- ventilation ratio	30:2	30:2 (single rescuer) 15:2 2 rescuers

NSP-Approved CPR Providers - 2007-2008 Polices & Procedures

14.3.4.1 All active NSP members must demonstrate their CPR skills each season, regardless of the certifying agency’s requirements or the expiration date of the card. (All active NSP members must hold a current professional-rescuer CPR certification from the American Heart Association, the American Red Cross, the National Safety Council, the American Safety and Health Institute, or Medic First Aid. This training must include breathing and cardiac emergencies, and adult, infant, child, and two-rescuer CPR techniques.)

15 Dec 2008 - OEC Technicians - Many folks may be under the impression that a candidate must successfully validate the OTH OEC scenarios before they complete/PASS the OEC Course.

NOT TRUE!!!

When a candidate successfully completes all OEC classroom requirements (written exams and hands-on scenarios) they have, for all intent and purpose, completed/passed the OEC course. They are indicated as a PASS on the CCR. When processed by the National office, become a registered OEC technician in the NSPS. An OEC Technician card is mailed direectly to the member from the National office.

OEC Technicians are NSP members and non-members alike only passing the OEC classroom curriculum. They are issued an OEC technician card just like every patroller. To remain current and retain the OEC technician qualification, there is an annual OEC refresher obligation. The fact that they have not completed any OTH portion and achieved a patroller status is not relevant.

OTH training IS NOT a factor in holding the submission of your CCR. OTH OEC scenario validation is required for the candidate to advance to a "Patroller" classification.

Candidates not completing OEC classroom course requirements by the original registered stop date must be listed as an "INCOMPLETE" (Inc).

Waiting for a candidate to complete all course requirements is no excuse for a late course close-out record. It's not fair to those that have completed the course and it prevents the proper/timely updating of NSPS education profiles.

The late course clock starts ticking 2 weeks after the registered stop date.

Any candidate completing course requirements after the original stop date is submitted on a "SUPPLEMENTAL" CCR with the SAME ORIGINAL COURSE NUMBER. The "PASS" block is checked instead of "INC".

A statement in the REMARKS block should indicate the reason for the supplemental submission, i.e. "Supplemental CCR submission for previous INCOMPLETE student(s) that PASSED/completed all Course Requirements/Objectives".

NOTE: There is a new National CCR form. It now requires an Instructor/Trainer (IT) of Record (ITOR)signature as well as the Instructor of Record (IOR). Click for the European Division CCR version of this form. It's a protected Word .doc file. Download and just tab through the blocks of information and type in what is needed. Print it, get the appropriate signatures. Scan and email the CCR to the POCs indicated below.

It may be a bit more admin work on the part of the IOR and coordination with the ITOR, but it keeps within the timelines for processing of the CCRs and the European Division off the National radar screen.

Submit all CCRs through the Division Registrar (Mike Pangman) and cc the Asst Division Director (Ski Dog). The Registrar will forward everything to the National office for you.

Bottom Line: Candidates should be coming to OTH training as registered OEC technicians. Don't forget to have the $60.00 OEC course fee for each candidate processed with National well before course closure. Scroll up for details on the Course Fee requirements.

On-the-Hill (OTH) training begins in January. In most cases, all candidates should:

Have completed the OEC classroom portion to include all written /practical exams,
Be OEC Technicians,
Possess a CPR - for the Professional Rescuer card,
Have a working knowledge of ski/snowboard removal and toboggan loading concepts.
Have an OTH training 1st Aid Pack loaded with all mandatory/required OEC supplies and equipment from the Division OEC 1st Aid Packing List.

If any of the above requirements are not met, the weekend training coordinator must be advised of this so alternate arrangements can be made if necessary.

When you have a moment, check out:

The OEC Zone Stroke Awareness

Foreign Medical Phrases Extract from AE Pamphlet 40-7

Division OEC 1st Aid Packing List

OEC Vital Signs Memory Jogger