QUESTION AND ANSWERS
Q: In the score sheets for Command and Technician there are some predetermined times. Do these times define when procedures should be completed?
A: The times are a guide for the Assessors to determine the duration of certain activities. They are not a fixed time as each scenario has different factors that will influence how long an activity will take. They also act as an indicator for teams but teams should not take the times as a fixed reference point for scoring.
Q: Will the team know prior to the test the patient’s condition, i.e. whether or not the patient is critical, whether or not the patient has an entrapment?
A: The team will not know the patient’s condition; the medic of the Team should perform a triage to determine injuries, condition, and other necessary information.
Q: Is there a specific time for each scenario?
A: Each scenario has a maximum time of 25 minutes. The Team should perform the patient extraction based on their experience and the condition of the patient(s). Before the start of the scenario, the Assessors, together with the Quality Control Officer, will define the optimal duration of that scenario based on a range of contributing factors. If the stipulated time is reached, the team will be able to continue working up to 25 minutes, but this will have a bearing on the scoring.
Q: How can we know the time set for each scenario?
Based on your experience and knowledge as a rescuer, you will be able to determine an optimal time to extract the patient(s) using patient-centred rescue and the use of best practices.
Q: Will there be a system that guarantees the greatest uniformity in the complexity of the Extrication scenarios in each of its three established Tiers?
A scenario weighting program has been designed that includes a range of possible variables. Once the scenario is designed, its complexity level is determined through a weighting exercise. When the scenario is assembled at the event, the Quality Control Officer with the assessing team confirms the accuracy of the weighting. Small adjustments may be made to achieve the weighting value originally established when the scenario was designed.
Q: The criteria in the extrication medical guidelines establish a time in some parameters, do they directly influence the score obtained?
In the Extrication Medical Guidelines, the allocated times are a guide for the assessor and teams. The scenario weighting will provide a tool for assessors to make adjustments based on the complexity of the scenario and the condition of the patient.
Q: Will there be hybrid or electric vehicles for the scenarios?
There is a possibility that hybrid or electric vehicles will be used we are waiting for final confirmation. If they are not provided, we may look at simulations, marked by labels. We will confirm at the captain’s brief.
Q: The guidelines present a chronological order of development of the activities; can the team carry out work outside of this sequence?
The guides have been designed in this way to make it easier for both teams and assessors. Each team can adopt its own system of work. The important thing is that all the established parameters are met, actions are patient-centered rescues and activities are safe and effective following good practice.
Q: Will the event organisation have a specific brand of reciprocating saw blades in the equipment supply? Could the team use their own blades?
A: One of the principles of the rescue challenge is that there is fair play between all the teams, therefore, the teams must use the blades supplied by the event hosts and sponsors.
Q: With the new evaluation guidelines, will the scenarios have different numbers of patients?
A: Yes, there could be up to 3 patients with different levels of injuries. There may also be uninjured passengers or role players added to the scenario.
Q: We normally cC2:D11ompete as an ALS team, so this is our first BLS competition. I saw the equipment list and it states that there will be multiple pieces of equipment in a trauma bag for us. Will there be a trauma bag for each team member? I know the bag only contains 1 BP cuff. Will we have more cuffs or do we need to pass it around?
In the last e-mail that states we «»can»» compete as an ALS team. Now I understand that this may be something that the WRC is considering for the future but I can’t imagine it working out for teams that decide to compete as an ALS team. For example, if we perform intubation, IVs, and provide medications, this would take extra time. Procedures that we wouldn’t be judged on. In the e-mail it states «»Teams will not receive additional points for advanced skills or procedures but may benefit from operating as they would on the road»».
Are the teams that want to compete as an ALS team given more time for the scenario?
I think in the future, there will need to be an ALS team competition that is separate from BLS. It’s not fair or possible to have ALS and BLS teams competing in the same scenario. The use of IVs, fluids or blood products, and analgesics are very prevalent in trauma competitions. Allowing some teams to do these procedures and then not grading them just doesn’t seem fair.
A: As you have rightly stated, the WRC has traditionally been a BLS challenge and for 2023, all teams have the option to participate as a BLS team. The rules for the Trauma Challenge have not changed for many years, and have not kept pace with the skill levels of first responders worldwide. Moving forward into 2024, teams will be expected to participate at their highest skill level. Not yet determined is the exact format the 2024 challenge will take. Other countries have integrated multiple skill levels into a single competition with a variation in KPIs for the skill levels participating, with a spread of skill levels being represented across the results. Receiving additional points for advanced skills disadvantages teams/ countries who do not have the ability to perform these skills. The cost and logistics of introducing a separate challenge could prove prohibitive to moving the Trauma Challenge forward, increasing scenarios by a few minutes may be an option for future Trauma Challenges.
There will be 1 trauma bag per team with the items available included in the Trauma Challenge guide. Teams are encouraged to bring any additional equipment they may choose to use either as BLS or ALS in another small trauma bag and/or vests. Teams should consider how they would operate on road in the normal working environment, and not seek to gain advantage. All additional equipment is required to be presented during the team meeting prior to the challenge commencing.
To reiterate, the option to use advanced skills during the Trauma Challenge is voluntary. If you wish to challenge yourself and your skills, I encourage you to excel in your BLS skills and use the additional skills within your scope as time allows. If you wish to compete at a BLS level and not use any additional skills, that is OK too.»
Q: For uninsured patients do they do a head-to-toe assessment of this person?
A: An appropriate assessment should be completed to identify if a person in or near the vehicle is injured. If they are considered not to have any injuries a full head-to-toe assessment is not required. As someone involved or a witness to the incident, their information should be passed to an appropriate person, in the challenge format that person is an assessor. If they are injured, then an appropriate assessment should be completed.
Q: If the patient is not hurt/trapped is the person escorted somewhere and handed off to someone else and a report given?
A: If unharmed, the individual should be escorted to a safe area and handed off to an assessor with a very brief report. Further information can be provided during the final medical handover.
Q: Do teams ask the patient if they are injured and get confirmation that they are not injured/trapped? and then what?
A: Yes, if they are in the vehicle and can self-extricate then assist them to do so. Briefly check their condition and hand them over to the medical assessor
Q: Do they ask the patient for information about the incident?
A: Do what you would normally do; Patients and bystanders are a source of information that may help with decision making and the overall rescue. They may also be able to provide details of other patients in the vehicle.
Q: How does assessing this patient impinge upon the expected times? Will it affect the scores?
A: If managed correctly, it won’t. All patients have been considered in the scenario weighting and where appropriate allowances are made.
Q: How does communicating with this uninjured/un-trapped patient affect the time it takes to get to the entrapped/injured patient?
A: This depends on the scenario, but this type of factor has been considered in the scenario weighting.
Q: What does the Team/Command do with bystanders?
A: Hand them over to a responsible person (an assessor)
Q: The guidelines mentioned vehicle data sheets. Will these be provided? Which ones will be used? How do we get copies?
A: We are waiting for confirmation about the vehicles. If it is feasible, we will provide a laminated copy of the vehicle data sheets. Further details will be provided in the captain’s brief.
Q: If there are bystanders or non-injured or non-trapped people on the scene, how does the medic identify and communicate the initial level of consciousness of all patients within 1 minute? Or does it mean within 1 minute of encountering the patient? or does it mean the medic performs a triage of all patients, un-trapped/un-injured/bystanders, as well as trapped/ injured and then gives the IC a report within 1 minute. When does the time begin? and if it is difficult to get to the patient, how does that affect the 1-minute time frame?
A: The time starts from entering the pit. The 1 minute is a guide and will be amended by the assessing team based on the number of patients and complexity of the scenario. As part of the team communications, the number of people involved, including bystanders, should be discussed and their status confirmed ie One bystander, no injuries, one person self-extricated before arrival, minor facial injuries etc…
Q: When you say «Identifies all of the injury/medical issues in < 5 minutes» or «Identifies & Communicates medical/physical entrapment within 3 minutes», does this mean 5 or 3 minutes from the beginning of the scenario or 5 or 3 minutes from gaining access to the patient? How does the assessor account for this? The times may be affected if the medic has to deal with un-injured/un-trapped patients or bystanders.
A: These times are from the beginning of the scenario; they are a broad guide. Each scenario is weighted and times adjusted accordingly, this information will be provided and agreed upon by the assessing team before each scenario.
Q: There needs to be some clarification on the difference between an Immediate Plan and an Emergency Plan.
A: Immediate plan is the patient’s condition has deteriorated and is about to go into cardiac arrest and needs to be out of the car immediately (in the real world, this may include cars on fire etc) An emergency plan is for when a patient’s condition could deteriorate.
Q: Teams are still unsure of how the Scenario Weighting system works.
A: The weighting is determined by how much work a t team has to do to extricate all the patients. The process will be shared during team updates.
Q: We believe Teams will not know which Tier they will encounter, only the Assessor will know this.
Q: How are points awarded and times affected by the scenario difficulties and complications (i.e. Additional patients), etc.
A: All scenarios are marked against the criteria in the guidelines. Scoring will encompass all aspects of the scenario; if you have two patients and treat one perfectly and the other one poorly, you will be scored on the basis of doing some good work but not being consistent, just the same as other areas such as PPE. Time allowances for scoring have been adjusted according to the complexity of the scenario, the number of patients and their injuries. For multiple patients, two plans per patient are expected to be implemented; these scores will be averaged to ensure fairness in scoring.
Q: When should a patient’s information be transferred to the medical advisor?
A: This transfer must occur once the patient is outside the vehicle and has been transferred to the safe patient area, once he or she is in the designated area for medical care.
Q: As a general rule, should two types of release plans be selected and carried out for each patient?
A: Yes, in general, two types of release plans should be selected for each patient. These plans include a main plan adapted to the patient’s current state and environment, which needs more space and time to ensure safe handling and extraction, and a secondary plan designed to prevent changes in the patient’s condition, requiring less space, but offering less safety in handling and extraction, and, therefore, less execution time. This choice aims to improve the patient’s chances of survival in case of changes in their health status, addressing situations ranging from stability to cardiorespiratory arrest.
Explanation of the Main and Complementary Plans in the Rescue
Q: In what order should these plans be carried out?
A: First, the plan must be implemented with less space and, therefore, less execution time, followed by the plan that requires more space and, consequently, more time for execution.
The order of implementation of the plans will be as follows, based on the available information:
- If the environment is safe and the patient is stable, the Complete Plan will be chosen as the main and the Emergency Plan as complementary. It will start with the Emergency Plan, which will be executed faster, and then continue with the Complete Plan.
- If the environment is safe, but the victim is unstable, the Emergency Plan will be chosen as the main one and the Immediate Plan as the complementary one. You will start with the Immediate Plan, which is faster, and then you will execute the Emergency Plan.
- If the environment is unsafe and/or the patient is at risk of life, only the Immediate Plan will be implemented since its execution will be faster and will be the only plan necessary in this situation.
Note: any entrapments must be released to ensure the plans are viable options.
Q: What level of control are we expected to maintain in relation to risk management?
A: The expected level of control shall be the most appropriate to address, mitigate or neutralise the specific risk. If the Technical Advisor determines that too much time is being spent on this task, they may consider whether they deem it appropriate that such risk is controlled. The main objective is to take into account the risks and take appropriate measures, but without consuming excessive time, to maximise the time available for rescue operations.
Q: Is the maximum time to complete the manoeuvres 25 minutes?
A: No, one of the main objectives of this WRC is to simulate scenarios as realistic as possible and that the rescue is focused on the patient and his environment. The time needed to complete the manoeuvres will depend on the clinical situation and scenario. There will be situations where it needs to be resolved in less than 12 minutes, while others might require more than 15 minutes, and so on. In summary, 25 minutes represents the maximum time allotted to perform a scenario, regardless of whether it has been completed or not. All scenarios should be handled within this time frame.
Q: If I notice that the maximum time of 25 minutes is running out and the selected main plan has not yet been completed, can I resort to the complementary plan for the extraction of the patient?
A: No, since the change of plan does not focus on the patient’s clinical situation or the scenario but even time stipulated by the WRO for the completion of the scenarios. The supplementary plan should only be used in the event of a real change in the patient’s clinical situation, i.e. a worsening and/or a change in the situation of the scenario requiring faster removal.
Q: In a scenario where there are two patients inside a vehicle and, after an initial assessment, one of them presents a cardiorespiratory arrest, what is the appropriate procedure? Should an immediate extraction be performed and the situation communicated to the medical advisor, or should the patient be marked with a black label and left in their current location?
In a scenario where we have two patients inside a vehicle and one of them, after the initial assessment, is in cardiorespiratory arrest, it is essential to prioritise patient care. You should follow an immediate plan to remove the patient in cardiorespiratory arrest and begin cardiopulmonary resuscitation (CPR) manoeuvres immediately, following first aid guidelines and protocols.
At the same time, you must inform the medical advisor about the situation and the actions you are taking, and he will decide when you will stop CPR.
Q: Will there be a scenario where lifting is required? If so, what equipment is provided?
A: Yes, some scenarios may require vehicles to be raised. High-Pressure Air bags will be provided.
This is the equipment that will be provided. You will be given an opportunity to familiarise yourself with the equipment. https://vetter-rescue.com/pdf/Vetter-Rescue-Catalog.pdf#page=8