Coventry University competes for Pilsen Cup of Paramedics

Day one: navigating night-time scenarios

Friday night was the start of the competition. We were given a comprehensive kit bag and a mobile phone to receive our scenarios through. After dinner there was a brief for our team leaders, who we nominated earlier in the day by the diplomatic method of ‘shortest straw’, about the agenda for the evening. After this we were asked to wait in our hotel rooms until the phone rang giving us our first scenario.

Our very first task was located a few miles down the road and thankfully, we were given a lift. Upon our arrival we were told that this was a major incident scenario. One person on the team acted as a controller and the other two as the first crew on scene. The scenario was set in the basement of a restaurant, initially in the dark using only head torches for light. We were met with some small obstacles and a child's play mat, portraying a village using dolls and cars to depict a major incident. There were several emergency service vehicles around the town and our task was to run a major trauma scenario acting as the first crew on scene with another team member as a controller some distance away. As a crew we were given a radio for communication and a tablet device with a slideshow showing the casualities involved in the collision and the extent of their injuries and vital signs. The controller also sat in the dark away from the scene, using just a head torch to move resource cards around and a radio to communicate any resources required by the on scene crew.

Luckily, we were just finishing our module in clinical decision-making at university, including a day long taught session in major incidents and mass casualty treatment. After 15 minutes of lots of talking, sweating and a little confusion, this scenario finished and we were whisked off to wait for the next scenario. At this point we didn't really know how many scenarios we'd be doing but were told we should be finished by about 3 am. So, with adrenaline still rushing through our bodies, our second scenario came through a short while later.

The controller passed details of a 30-year-old male patient, called Mr Novak, complaining of abdominal pain on the second floor of a hotel. Leaving our room, we were guided to the lift. After summoning the lift the doors remained closed but we heard people inside shouting, clearly in distress. After a little confusion and translation we established there was a woman in active labour inside and no way to get in. We briefly discussed the scenario and when told that no other resources were available, we concluded that the task was to give instructions to the people inside to deliver the baby safely. This ran smoothly with a positive result at the end for all in the lift…until we were questioned about Mr Novak upstairs. We all forgot about Mr Novak, something we found out later we were not alone in. This was a glimpse of what was yet to come and thankfully for us, the end of our night.

Day two: rivers, moutain rescue and road traffic collisons

Bright and early on Saturday all of the teams met for the days brief. Some teams hadn't completed their scenarios until 05:30 am, so we felt quite lucky and reasonably refreshed completing at about 02:00 am. We were given a map with 11 different waypoints located over a large area, including several mountains. Our task: carry all equipment required to navigate around the national park, stopping off at all 11 scenarios and dealing with each one appropriately. Easy, right?

Our very first task began with rescuing a man by negotiating our way across a river using rope rescue techniques. Not so easy now, but incredibly exciting and challenging. Two of our team were harnessed up and zip-wired over the river to the plot of land where the man was located and we established a possible arm fracture, which we splinted. We then assisted the casualty to a nearby boat and travelled across the river to the other side where the emergency vehicles were waiting. The assessors told us the task was marked mainly on the time it took to complete. Taking into account that one of our team got a little stuck half way while traversing the zip-wire, resulting in being pulled back and starting again, we felt we needed to make up points on the subsequent scenarios.

While reflecting on the first scenario of the day, we started our 4 km walk to the second waypoint. After meeting one of the assessors here, he told us that there was a man in a tree threatening suicide. There was a noose wrapped around the tree but it was not attached to the patient. One of our team took the lead, as it was felt that all three of us approaching could make the patient agitated. The root of the problem was quickly deciphered, and by negotiation we helped the patient out of the tree to a place of safety. Marks calculated, sun block applied, we started off to the next waypoint.

Scenario three in contrast involved two patients, both with significant gunshot wounds. One was alert, shouting loudly, and the other was unresponsive. We decided that one of our team attended to the casualty with a higher GCS and two attended to the casualty who was unresponsive. This casualty sustained two gunshot wounds to his abdomen with catastrophic haemorrhage present. We attempted to control the bleeding but the casualty deteriorated quickly and subsequently arrested. This meant we had to divide treatment, with one of us controlling haemorrhage and one undertaking basic life support.

Across the tent where the other patient was still shouting, our teammate conducted a full trauma assessment on the other casualty who also presented with a catastrophic haemorrhage from a femoral injury. This was quickly noticed and a stepwise approach was used to control the bleeding, resulting in a tourniquet being applied. For a brief period, the fact that this was a mock scenario was forgotten and the patient had to remind our teammate of this. But with fake blood spurting out, a gun on the floor and a confusing situation it was very realistic. This scenario highlighted the importance of communication among the group, how important a thorough examination is and how realistic scenarios can be highly effective. The importance of overcoming language barriers, different guidelines and treatment was also highlighted, with UK paramedic practice noticeably more autonomous in comparison to the Czech practice.

Another enduring walk in the mountains led us to our next scenario. We were met by the Czech mountain rescue team and tasked to rescue a parachutist out of a tree around 40 ft high. While the team were getting the casualty down she lost consciousness. When we examined her we noticed that she had sustained crush injuries from the harness she was wearing. Each of us had little exposure to this injury and we could have avoided this to an extent by asking the casualty to move her legs while in the tree to improve circulation. This was a learning curve and one that will not be missed in the future. The fifth casualty was located in a house under construction. He presented as confused, with empty beer bottles all around but upon further examination we established he was hypoglycaemic and we treated as per the UK Ambulance Services Clinical Practice Guidelines, a further noted difference between UK and Czech practice.

Another walk through a large forest led us to the most enduring scenario of the competition. This was a road traffic collision involving a rolled over ambulance and three patients. On reflection, we noticed that there was a distinct lack of leadership between us all and a lack of satisfactory amounts of communication—possibly due to fatigue and the effects of the hot weather. As we took a casualty each, we acted as though the others were not there and adopted a ‘tunnel vision’ approach rather than a dynamic one. However, one of the team members did attempt to have an overview of the scenario but there was a lot happening at one time.

All involved were treated to a high degree but the task could have run a lot smoother. We were getting very tired at this point after the demanding challenges we had faced so far, and were only just over half way through. A short walk away this time allowed us to recuperate before being faced with a paediatric patient with burns from a fire who had managed to drink a bottle of wine. This was a great scenario and one that we managed well. The casualty was celebrating a public holiday in the country when he got too close to a fire. On arrival the casualty had low Glasgow Coma Scale (GCS) and burns to his face and body, roughly around 15% in total. We ruled the lowered GCS to be the alcohol the child had consumed but considered other possible causes, gaining valuable marks from the assessors.

The eighth scenario was a series of tasks where our team working and problem solving skills were put to good use. This also gave us a chance to make up for the road traffic collision scenario. The tasks involved drug calculations, a relay race, setting up an infusion pump, bandaging and ampoule breaking. The main challenge here was to complete all tasks within the quickest time. The only injury present was a pair of trousers that a team member was wearing whilst he was partaking in the relay race. All of which was caught on video much to his frustration and others amusement. Having had a rigorous day of trauma scenarios the next two were medical scenarios. The first involved a male roughly in his twenties who was discovered in a swimming pool by a lifeguard and now presented with shortness of breath and was hypothermic. Here, we removed the patient from the pool and then set about assessing and treating. We were unsure about the underlying cause but treated the vital signs which he presented with and managed the patient accordingly. The other medical scenario was a couple in a hotel, with the wife complaining of lower abdominal pain. After questioning and a thorough examination we concluded the patient was experiencing an ectopic pregnancy, again scoring vital points.

After an exciting, yet exhausting day we had one final task which we had to complete. Thankfully this was back at the hotel we were staying at. We were faced with a patient who was intoxicated, agitated, aggressive and had a vast amount of knives and drug paraphernalia in the room around him. To make the scene more realistic there was also the sound of a large sounding dog in the next room, a further danger to control. Approaching cautiously, we considered police assistance and talked to him from a distance where he was compliant with our demands. We were able to remove several knives and ask him to put the dog away. All was going well until he walked into another room, felt an intense pain in his chest, collapsed and suffered a cardiac arrest. The patient was replaced with a mannequin on the floor connected up to a computer, which monitored compression rate and depth as well as ventilation rate and depth. We quickly identified the cardiac arrest and started advanced life support on this patient.

After the issue with teamwork at the road traffic collision scenario one of our team acted as a team leader, controlling the arrest and ensuring effective and efficient management of the scene. Careful observation allowed us to change the clinician on the chest to take into account rescuer fatigue. We were very pleased that after such an intense day that we still performed the advanced life support (ALS) scenario so well. We obviously impressed the assessing doctors as they came up to our lecturers after and congratulated us for the high standard of ALS and leadership that we possessed. Finally, and thankfully, after 10 hours of hiking and scenarios we were complete.

Conclusions

These scenarios brought all of the clinical and non-technical skills we had learnt in university into practice. Not only were our clinical abilities tested, but also our fitness, translation skills and ability to work under pressure over a sustained period. After nearly 24 hours of competition all the teams got together for the results. Following a lengthy score count and baited breath the winners were announced. We achieved second place overall, quite an achievement for a first attempt.

This trip has highlighted how beneficial an event like this can be for student paramedics and paramedics who are in practice already. The Czech Republic team hold this event once a year and as far as we know there is little in the way of this type of intensive training used in the UK. Coventry University staff and students are keen to hold an event like this in the future after our experience in the Czech Republic, and negotiation and planning is already underway. We want to thank all involved in the Pilsen Cup of Paramedics and wish to emphasise how valuable this has been for us. The competition ran so smoothly and long hours of vigorous planning must have gone into this to make it such a success.

This was an incredible experience and one which has enhanced all of the team's practice, but also resulted in a chance to be part of a European competition.