D2: Use of ‘Live Casualties’ during Training and Assessment

Introduction

This policy indicates how live casualties may be used to support training and exercises. It covers the use of live casualties when working at height and also when working in, near or on water, in a rescue training environment.

In addition, the policy covers the use of students in training activities and the requirement of consent for this to occur.

Policy

The use of live casualties is to be avoided unless essential to the outcomes required.

The requirements to use a live casualty will be based on careful consideration of:

  • Risk Assessments
  • Training needs

The benefits to using a live casualty must be clearly defined and outweigh any hazards or risks.

Participants must consent to being used in scenario activities.  However, participants may withdraw consent at any time.  If consent is withdrawn, then the task must not commence or continue with the affected participant.

Refusal or withdrawal of consent may have an impact on the student’s achievement of their learning outcomes.  This must be made clear to the student, without placing them under undue pressure.

General Considerations

When training in hazardous environments, the part of the casualty or victim is generally best served by use of a training manikin. Manual handling considerations must be taken into account, particularly during the placement of a manikin for rescue and care.

There are circumstances where risk to personnel in placing the manikin in a realistic rescue situation is such that the activity should be avoided. Risk assessment of training sites will identify such locations.

There are times when the experience of working with or receiving continuous feedback from a live casualty is a key part of learning (e.g. for casualty handling) and the required learning outcomes cannot be met if a training manikin is used.

When competent specialist personnel undertake the role of the casualty, valuable feedback on performance can be provided with safety observations and direct instructions being given as needed.

The guiding principles for the use of live casualties should ensure that:

  • The use of live casualties is avoided unless essential to the outcomes required.
  • Any exposure to risk is justified and effectively managed to achieve clear and established learning outcomes.
  • The risk is not disproportionate to the benefits.
  • The risk to the ‘casualty’ should not be greater than that to the rescuer.
  • Live casualties are used when casualty care is the prime objective of the training session.
  • Live casualties are provided with appropriate PPE, including a separate safety system as appropriate.

A live casualty should be an individual competent to work within the environment they are placed. The “casualty” must in addition to the general considerations:

  • Fully understands the purpose of the exercise
  • Fully understands any interventions or physical examinations that may take place
  • Fully understand any emergency plan actions that may be required
  • Consent in writing to being used as a casualty

Working in, near or on Water

A live casualty should be an individual competent to work near, on or in water and (where applicable) at height. The “casualty” must in addition to the general considerations:

  • The ‘casualty’ remains in visual contact with a trainer at all times.
  • Fully understands the purpose of the exercise
  • Fully understand any emergency plan actions that may be required.

Management of consent

Whilst it is recognised that the experience of acting as a casualty / patient / Care provider is valuable, due consideration must also be given to the rights of the student to withhold or withdraw consent to participate in the activity.

ORMS requires student consent prior to participating in training activities.  There are two types of activity that students may participate in, these are:

  • Participating in activities that ARE NOT required to achieve the student’s own learning outcome or assessment.
  • Participating in activities that ARE required to achieve the student’s own learning outcome or assessment.

The activities may be further divided into participation as a patient or participation as a care provider.

Students are informed of the requirement for consent and their rights to withdraw consent at any time.  They are also informed of the ramifications of non-consent if linked to a required activity to meet the learning or assessed outcomes of the course.

Students are required to provide consent in writing by completion of a student consent form on commencement of their studies.  This consent is enduring for their period of study with ORMS.  Students are informed of the exact nature of participation prior to each task, thus giving them opportunity to ask questions and ensure they are fully informed prior to the task commencing.  Students retain the right to withdraw their consent at any time.

Consent withheld or withdrawn

When consent is withheld or withdrawn the tutor will ensure that the student is not unduly disadvantaged and that, if possible, an alternative method of achieving the learning objective is used.

Activities are categorised as follows:

  • Not required to achieve learning outcome or assessment
  • Required to achieve learning outcome or assessment

Not Required

If the student withholds or withdraws consent to participate in an activity that is not required, then their wishes are respected and the student is supported.  The student may observe the task or participate in a limited capacity, in a manner that is mutually agreeable.  This will not affect the student’s grades, progression or achievement.

Required

If the student withholds or withdraws consent to participate in an activity that is required, then the student is reminded that it may affect their achievement of stated learning outcomes or the associated assessment.

If the student still withholds consent then their wishes are respected and the student is supported.  The issue is reported to the module lead where remediation may be arranged or further action taken if necessary.  This is likely to affect the student’s grades, progression or achievement.

Role Play scenarios / assessment

Health and Safety (H&S)

All role-play scenarios and/or assessments will be facilitated as a ‘real-life’ incident.  However, all H&S issues will be addressed to ensure that risks to students are minimised to as low as reasonably practicable for the activity.  The monitoring tutor will continually risk assess the situation.

Nature of scenario / assessment

All ‘role-play’ scenarios facilitated during the course will be relevant to the stage of study of the students, and the correct level of clinical intervention.

Patient condition

All students agreeing to enact in the role-play as a patient will be provided with a briefing that will clearly outline the patient’s condition.  This detailed information will include signs and symptoms, and tips on acting within the stated role.  Where possible, casualty special effect makeup will be utilised.

Appendix 1 – Obtaining Consent

This procedure must be followed for obtaining consent from a person acting as a live casualty or a student participating in activities.  The details of the procedure will be stated within the module handbook and the policy is freely available through the ORMS intranet site http://intranet.orms247.co.uk

Introduction

As part of the programme, individuals are asked to act as patients, relatives, bystanders or caregivers during the facilitation of role-play scenarios / assessments.  Individuals will enact these roles to allow course peers the opportunity to undertake a ‘real-life’ incident involving a wide range of clinical assessment and interventions.  All role-play scenarios / assessments will be monitored by a paramedic tutor / specialist assessor (i.e. clinician, senior nurse etc).  In addition, students are required to work in an operational setting with their Practice Placement Educator/s (PPEd), whilst doing so, they are required to complete competencies linked to practice within their Ongoing Record of Achievement (ORA).

Procedure for obtaining consent

The procedure for obtaining consent is as follows:

 

 

 

D2: Live Casualties Declaration of Consent Form

(a downloadable form is here)

By student to participation in role-play scenarios or Objective Structured Clinical Examination (OSCE)

I understand the range of practical activities, and I agree to participate as a model in classes and on clinical placements in a variety of settings for the duration of my study on the programme.

  • I understand that the term “model” can be applied to practical skills sessions, role-play and practical examinations.
  • I understand that unless health issues have been disclosed I am at present in good health
  • I understand that should any information regarding my health status be discovered during a practical procedure, it is my responsibility to seek appropriate advice. This may include referral to my General Practitioner or other appropriate health professional.  Wherever possible, such information will remain confidential.
  • I understand that it is my responsibility to inform my Personal Tutor of any change in health status occurring since completion of this consent form and any subsequent change during the next academic session. (Failure to do so may have implications on you continuing the programme).  Outreach Rescue Medic Skills or the faculty cannot be liable where there has been incomplete or non-declaration of any change in health status.
  • I understand that it is my responsibility to inform the Programme Team of any disability/special needs. Outreach Rescue Medic Skills or the Programme Team cannot be liable where there has been incomplete or non-declaration of any changes.
  • I understand that a practitioner holding a recognised qualification, which is deemed appropriate by the Outreach Rescue Medic Skills, will introduce practical skills in a teaching environment.
  • I understand all tutors will discuss indications, contraindications and hazards of any technique to be performed.
  • I understand all tutors will demonstrate, using safe practice, all skills that may be performed on me.
  • I understand that information in respect of the known risks and limitations of the practical procedure(s) will be made available to me prior to experiencing the practical procedure for the first time.
  • I understand that I can ask questions and discuss all techniques with the appropriate tutor at any time.
  • I understand that, where appropriate, it is my responsibility to ensure that I have undertaken adequate self-study prior to undertaking the practical procedure.
  • I understand that it is my responsibility to be aware of the precautions and contraindications for each of the practical skills.
  • I understand it is my responsibility to inform either the Module Leader or a member of staff who is teaching that particular skill if I feel unable to undertake any of the skills for whatever reason.
  • I fully understand that it is my responsibility to inform the member of staff/student should I experience any untoward symptoms during the procedure. I acknowledge that it is the responsibility of the student to stop the procedure immediately should I indicate such symptoms or request that it should be stopped.
  • I understand that I have the right, at any time, to withdraw from the procedure, or part thereof. Furthermore, I understand that this may affect my achievement if the task is required to achieve a stated learning outcome.
  • If consenting to take part in a practical procedure, I understand that I may be required to remove clothing appropriate to the learning outcomes, which may prevent observation and / or examination in order to undertake some practical skills effectively.
  • I understand that it is my responsibility to inform my Programme Team of any change of my status with regard to criminal convictions since completion of my enrolment and any subsequent change during the next Academic Session. (Failure to do so may have implications on you continuing the programme).  Outreach Rescue Medic Skills cannot be liable where there has been incomplete or non-declaration of any changes.
  • I understand that I am free to refuse to participate in acting as a model in practical classes.
  • I understand that if I give consent at this time, I may withdraw it at any later time. Should I choose to do so I will ensure the matter is discussed with the appropriate member of staff.
  • I understand that should issues of concern arise I will discuss them with an appropriate member of staff.
  • I understand that I must behave in a professional manner in accordance with the Health and Care Professions Council Standards of Conduct, performance and ethics, the Health and Care Professions Council Guidance on conduct and ethics for students and Outreach Rescue Medic Skills policies and procedures.

I declare that I have read and fully understand that the above are important aspects of undertaking any HCPC approved programme with Outreach Rescue Medic Skills.

Student Name             ………………………………………………………………….

 

Signature of Student    ………………………………………………………………….

 

Date                            ………………………………………………………………….

 

Student Number          ………………………………………………………………….

 

In addition and in accordance with the Data Protection Act, [ I DO ACCEPT / I DO NOT ACCEPT ] (Delete as appropriate) that any digital media obtained during the course may be used for training, publicity or other similar uses.

Declaration of Confidentiality

 

I, ……………………………………………………………………… hereby declare that I will hold in strict confidence any personal information concerning patients which may become known to me during my duties in any of my clinical placements and that I will not divulge such information to any unauthorised person nor discuss it with my colleagues in any public place.

I understand that such confidential or personal information includes patient’s diagnosis, treatment and other particulars relating to his or her condition.

I understand also that the disclosure to unauthorised persons of confidential information concerning patients is classified within the disciplinary rules as conduct that may warrant dismissal.

 

Student Name             ………………………………………………………………….

 

Signature of Student    ………………………………………………………………….

 

Date                            ………………………………………………………………….

 

Student Number          ………………………………………………………………….