The core concept of this project is that paramedics can become a more "value-added"
addition to the demining team by practicing their skills more effectively
and integrating them more fully with the demining team. Too often, it is asserted,
that paramedics in a mine action programs are underutilized resources who
are sometimes hired as add-ons to the program, are ignorant of other demining
functions, and who can, if not nurtured or allowed to enhance their capabilities,
easily become medically "de-skilled."
HMD Response paramedic training
Philip Garvin, Director of the HMD explains that since paramedics are often
after thoughts (added only in case there is a landmine injury), they are neither
integrated into the routine of mine action activities, nor do they get a chance
to practice their own trade. At best the paramedic becomes inactive; at worst
he looses confidence in his own techniques and may be as shocked by a landmine
accident as the victim!
The HMD Prescription
HMDís representative, Lieutenant Colonel Jane Davis has devised a program
which her organization believes alleviates both problems, and results not
only in developing a much more competent and confident paramedic, but one
who is a multi-faceted and valued member of the mine action team. The pilot
program was put into action in Angola, under the auspices of HMD and HALO
Medical Training for the Paramedic
The first goal of the HMD Paramedic Training Program was to enhance and focus
the medical skills of the team paramedic. The central theme of this phase
was standardization. Training techniques, medical procedures, supplies, equipment,
and even training devices were standardized so that training could be repeated,
evaluated, and transferred.
HMD created inexpensive trauma kits which paramedics could count on to contain
all necessary supplies. The major kit (a rucksack for the care of a major
injury) cost $300 while the minor kits (for the day-to-day care of deminers)
cost $100 each.
Paramedic treatment in the emergency
wing of the hospital
The training aids and corresponding supplies were made as simple as possible,
often using color-coded devices. Each deminng location was provided with a
mannequin for life-like and repetitive training. The HMD procedure refined
training to essential medical tasks, and concentrated on achieving complete
mastery of them. Colonel Davis believes that paramedics will often only have
a short time to prevent loss of life, therefore skills, which might distract
from more necessary and critical actions, were consciously avoided.
The training course was designed to be repeated after three months and then
again every six months, thus employing the concept of short, frequent retraining
courses. Through application of these techniques, HMD officials felt that
the paramedics were not only more confident and more capable of saving lives,
but that the deminers were happier because of the enhanced camp hygiene which
became a more practiced domain of the local paramedic.
Cross Training of the Paramedic
This leads to the second major goal of the HMD-HALO Trust effort: to extend
the role of the paramedic far beyond that of a first aid provider.
First of all, HMD wanted the paramedics to be seen in the primary health
role within the team. Paramedics were trained to perform daily tasks
which would improve camp hygiene and promote wellness among team members.
They were trained to oversee water purification, proper latrine selection
and maintenance, and to dispense proper elementary medicine.
Secondly, it was decided that the best way to expand the paramedicís concept
of understanding the people and their problems, was to work among them. Sometimes
they merely recorded the place of origin and route of displaced persons, but
such data is critical and the interpersonal and confidence-building skills
of the paramedics gained immeasurably.
|Jane Davis demonstrates use of her minefield
Thirdly, the paramedics were sent periodically and regularly into local hospitals.
There the effect was dramatic and somewhat unexpected, for while paramedics
gained invaluable experience and on-site training, the cooperating hospitals
were soon improved by the work and skill of the paramedics, especially in
the area of record keeping. Paramedics brought record-keeping skills (borne
of mine action training) with them and often initiated such procedures in
the hospitals they were supporting part-time. The Angola paramedics started
keeping patient records at 20-a-month, but soon expanded to 60-a-month. These
records provide critical and long-ignored data for future mine action projects
Finally, the Angola paramedics were tasked to support local mine awareness
activities. Mine awareness and victim assistance often go hand-in-hand and
certainly complement one another. Using paramedics as supporting members of
the mine awareness efforts, not only was cost-effective, but also allowed
for cross-over ideas from victim assistance to support mine awareness concepts
and vice versa.
The Future of the HMD Role for Paramedics
The HMD Angolan model of paramedic training has its critics. There are those
who say that the paramedics could be employed best by learning more advanced
medical procedures to be employed in tending a traumatized victim, and not
by expanding their role to other functions of mine action. But HMD makes a
convincing case for taking someone who is often seen as secondary to other
demining personnel and making him a more integral part of that effort. Such
a role enhancement would seem to increase mine action flexibility, improve
relations with local civilians and hospitals, integrate the various mine actions
teams, build a greater esprit de corps, facilitate paramedic training, and
enhance the esteem and confidence of mine action paramedics.