THE PARAMEDIC APPROACH

THE PARAMEDIC APPROACH APPROACH

The latest Dublin Fire Brigade recruits came through their paramedic training as Ireland faced a second wave of COVID-19. Course Director Karl Kendellen tells Adam Hyland how it was made possible.

“T his group of paramedics is a unique class,” Course Director Karl Kendellen tells me. “No other class in the history of Dublin Fire Brigade has ever had to experience this kind of training while under lockdown due to a pandemic.”

These are indeed unusual times, and while these latest recruits did incredible work to ensure they were brought through fire fighting training during the first wave of COVID-19, paramedic training for these and other firefighters has had to be carried out under various levels of restriction, making their graduation just as remarkable.

For a start, the class size was unusually large, with 56 on the course.

“It was a huge class,” Course Director Kendellen agrees. “We had 43 coming straight in from the recruit class, plus ten personnel coming back from operations, and three external students from Dublin Airport Fire Service. As well as myself, we also had Eithne Scully and Ray Kearney as Assistant Course Directors, eight syndicate officers, and tutors, bringing the teaching faculty to 19. So, there were a lot of people involved, all of whom had to be kept safe and who had to follow very strict regulations on distancing and hygiene that never changed even when the level of restrictions in the country were changing.”

Although the class was made up of new members as well as those who had gained operational experience, all of them were more than familiar with the safety measures that had to be followed, and this ultimately led to the class completing the course during what were difficult times.

“I think the operational lads had some exposure to how we could work under new guidelines because they were out in the stations,” Course Director Kendellen tells me. “Even though they weren’t yet trained as paramedics, they would still have been going to a lot of medical incidents on the fire appliances. So, they would have been familiar with the isolation techniques and the PPE. Those coming straight in from recruit training would have experienced how things had to work, and they knew no different, but there was some adapting to what we had specifically in place, and everybody fell into it very easily.

“Obviously, there were issues from the point of view of how we would typically run a paramedic class and what we could and couldn’t do under the circumstances, but the students just rowed in when they were asked to do something, or not do something, they facilitated everything as much as they could.”

Starting in September, the course ran through to the end of November, with COVID-19 regulations easing at one stage before being reinforced over this period, and at the time of writing all are now in the supernumerary phase of their internship, serving four weeks as an observing third person on the ambulance.

“This has been, and will be, an interesting time for them,” Course Director Kendellen says. “For those who came in straight from the recruit class, it has been a hard year. They got two weeks off after a very challenging recruit training course, before coming back in to the paramedic course, again under difficult circumstances.

“It is probably harder for those coming back in from operational work, because they have gotten used to shift work, and had to return to Monday to Friday, which is quite restrictive. And it’s not really nine to five, because there’s a huge amount of reading and self-directed learning that has to be done, so it is full on, it completely takes over their lives for 12 weeks.

“One advantage they have is that they have been out at cases and seen incidents – cardiac arrests, broken bones, soft tissue injuries – so they are able to put into context what they are being taught, whereas for those who haven’t yet had the experience, it is still very theoretical.”

Mannequins were used to simulate patient-led exercises to reduce physical contact between students. Students were able to remotely observe practical lessons.

Social distancing was adhered to at all times during training.

CHALLENGES

Regarding the course itself, Course Director Kendellen and his colleagues had to devise ways to deliver its component parts safely, which presented many challenges given the hands-on nature of the training, but he had good foundations from which to build.

“We used the foundations that were put in place by Course Director Tom Doolan when he took the recruit class,” he says. “We kept the pod system and the syndicate groups with one syndicate officer assigned to each to avoid mixing and the risk of contamination. But we did change a few things to take into account where we were at regarding COVID-19 and the second wave of the pandemic. Ordinarily, people would use their colleague or classmate for practice as a patient, and the nature of the course is that it is a physical, hands-on, skills course, but we used a lot of simulation mannequins instead of having people lying on the ground and being tended to by their syndicate members.”

There was also a lot of planning and back-up planning needed for each component of the course that had to be decided on, based on the restriction levels imposed to combat the pandemic. One example is the Mass Casualty training.

“We had several different plans for Mass Casualty,” Course Director Kendellen explains, “from preferably running a major incident in the way we would have done in the past with external services, right down to not being able to do anything at all, and everything in between. If we were to run it as before, we simply wouldn’t have been able to guarantee that we wouldn’t bring COVID in.

“Because of that, we had to take the traditional Mass Casualty incident and break it down into what one of the instructors described as a deconstructed mass casualty incident. We were able to run it on a circuit so we had eight different components, with each syndicate starting at one point and rotating through the circuit, so we were still able to manage it as one continuous exercise. Each group got exposure to all the learning objectives they needed to do, and all the practical skills they would need, but on a much more segregated basis. It was an innovative way to do it and we were still able to provide enough realism and practical simulation.

“There was, as always, a huge amount of effort put into making it happen, with all of the safety and COVID precautions on top of that, and it worked well, with the feedback very encouraging.”

There were also challenges when it came to the less physical, classroom-

Mannequins were used for all possible scenarios.

“Even though they didn’t get to bond as a unit, you could see that the class knew they were doing something special here”

based elements of the course, but this was also successfully completed.

“Apart from figuring out how we were going to manage such a big class and keep them safe, we also had to figure out how we were going to deliver the theory elements of the course properly,” Course Director Kendellen tells me. “Previously we could have had everybody in the one lecture room, but social distancing meant that for us this year we had to have the class split across three rooms.

“We ended up streaming from one room into the other two. From a tech point of view, we did have some difficulties, and it was a challenge for instructors to adjust to how they delivered their lectures to a streaming audience, rather than one in their lecture room, and the issues of how to keep that tutor-student interaction.

“Students were finding that if they weren’t in the room with the lecturer, it is hard to stay motivated and focused. We had considered running three parallel sessions and rotating the tutors, as they had done with the recruit training, but because of the nature of some of the topics, the lecture could be two or three hours long, and there just weren’t enough hours in the day to be able to do that. But we got through it.”

INNOVATION

The use of innovative technology helped in this regard, with an audio-visual system set up to run the abovementioned simultaneous lectures, but other new ideas were also brought in.

“We used a lot of the XVR simulation suite available to us,” Course Director Kendellen tells me. “For the Mass Casualty training, we were able to simulate a patient triage exercise on a big screen, almost like a video game, where we could have students walk through a shopping centre and triage patients, and this had never been done before for a paramedic course here.

“That was fantastic because when we couldn’t go off-site and commandeer a building, we could do it virtually. We have only touched on the huge potential for this, where we could stream learning exercises to stations. For future training there is so much opportunity for innovative training.”

‘Patient’ triage.

Course Director Karl Kendellen.

LEVELS OF RESTRICTION

The safety measures that had to be strictly adhered to remained the same as when the recruits first entered the Training Centre, but what differed for the paramedic class was the number of restrictions and relative freedoms that came in before the second wave hit, and this too proved to be a challenge.

“The move from Level 5 to Level 3 definitely provided more challenges because,” Course Director Kendellen says, “whereas the recruit training took place during full lockdown, paramedic training was taking place when some restrictions had been lifted, people

Mass Casualty training was separated into different groups but each retained the challenges ordinarily faced in this exercise.

One syndicate group tackling an RTC element of the Mass Casualty incident training.

could socialise, schools and businesses were open, so it was hard to manage and ensure that the students were all protecting themselves and their class outside of the Training Centre.

“Through no fault of their own, there were some instances when someone was tagged as a close contact of a positive case, which resulted in self-isolation, but we were always fully focused on how we could maintain the integrity of the course and ensuring we didn’t lose one or two syndicates at any stage through cross-contamination or exposure to infection.

“I won’t say we were lucky, because a huge amount of work went into keeping everyone safe at all times. All of the instructing staff, all of the people involved in running the Training Centre, and all of the students, worked hard to ensure they didn’t put themselves in any situation that could result in someone testing positive for COVID-19. One of our big fears was that if someone came in with a positive case, we could lose a third of the class, so there was a lot of work done to mitigate those risks.

ACHIEVEMENT

“To get 56 students through in the middle of a pandemic is a huge achievement, and something I am very proud of,” Course Director Kendellen adds. “I can’t speak highly enough of all the instructing staff who kept it moving, and the students who put a huge amount of effort into not going out and living their lives, because it is hard. Between recruit training and paramedic training it is 26 weeks, half a year, and to not be able to go out and let off steam is a big ask.

“Of course, it has been hard in that they haven’t been able to bond as a group in the same way other classes would have. That is an unusual situation to be in, and very different from other when you are literally living shoulder to shoulder with your classmates. The group realised this though, and even though they didn’t get to bond as a unit, you could see that they knew they were doing something special here, it was a very unique set of circumstances to be in, and I felt they were very proud to be performing so well, and not being stopped by the pandemic.

“To be able to get through that due to the hard work put in by the students, the faculty, and the mitigation measures put in place, was incredible. In fact, Brigade Training Officer Brendan Carroll mentioned that DFB affiliated with the RCSI were the only thirdlevel partnership or institution that continued face to face education throughout the pandemic, so that again is a great achievement.”

When distancing was impossible, students wore masks to protect each other.