Casualty Simulation May 2019

Page 1

VOL 43, No.2 MAY 2019





Casualty Simulation is the quarterly journal of Casualties Union

... NATIONAL & BRANCH NEWS ... TO SIMULATE REALISM IN THE TEACHING OF FIRST AID, EMERGENCY AND RESCUE HEADQUARTERS Box 1942. London E17 6YU Telephone 08700 780590 (Calls are at National Rates). E-mail: Website: HONORARY GENERAL SECRETARY Caroline Thomas E-Mail: _________________________________________


© Casualties Union 2019. All rights reserved. Material contained in this publication may not be reproduced in whole or in part, without the prior permission of Casualties Union. The magazine is published quarterly. The views expressed in this publication are those of the contributor(s) of the article and do not necessarily reflect those of the Editor or Executive of Casualties Union. The Editor will assume that any material has the full permission and consent of copyright owners before the material is submitted. It is the responsibility of the sender to obtain such consents. The Editor reserves the right to shorten or modify any contribution submitted. Casualty Simulation cannot be liable for the custody or safe return of material submitted. We will try to return such material as requested only if an appropriate stamped addressed envelope is enclosed with the submission. Whilst every reasonable care is taken by them, Casualties Union accepts no responsibility or liability for any action taken as a result of information contained in this publication.

_________________________________________ FRIENDS OF CASUALTIES UNION ASSOCIATE MEMBERS

VACANCY IN EXECUTIVE COMMITTEE The retirement of Edward Goodman leaves a vacancy among the Elected Trustees who serve on the Executive Committee. Paid-up members of any grade are eligible, so we encourage you to volunteer for this important work or to nominate another member who you feel would be suitable. Please notify the Hon. General Secretary on, or by post to Headquarters. CONGRATULATIONS TO THE FOLLOWING MEMBERS: Exemplary Service medal (15 years service) Patrick Carney, Helen Coppenhall, Steve Coppenhall, Margaret Holmes, Geoff Tickner. 25-year clasps Dinah Auton, Ronald Auton, Ronald Gubb, Fredda Thickins, Janice Waspe. 50-year clasp Stella Chapman. West Mercia Branch Member Level assessment Joan Brazier Geoff Dellbridge Josep MacMahon Alan Lewis Lisa Smith ALSO SEE PAGE 15 FOR THIS YEAR’S ITW TROPHY WINNERS

All members of Casualties Union receive free copies of this magazine. If you would like to join as a non-active Associate Member, the annual fee is £18 including postage, worldwide. Any extra amount you care to donate would be very much welcomed. Please make cheques payable to Casualties Union and send to the headquarters address as above.


Next Issue due August 2019 The deadline for submissions is 30th July, please ensure all submissions reach the Editor no later than this date. Please email contributions to Russ at: Or by post 12 PINE TREE RD, ULVERSTON, CUMBRIA, LA12 9HD


CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

VISIT • LIKE • SHARE • COMMENT casualtiesunioncharity CasUnionCharity casualtiesunion

Quiet Russlings Here we are already well into Spring with lighter evenings and the promise of summer round the corner. I just managed to include a report in this issue from the once again excellent ITW in Bristol. For any who couldn’t make it (including me unfortunately) it’s a great recap of the weekend, and for those who attended it’s a chance to revisit some of the bits you may have missed. Thank you to my ‘roving reporters’ Sarah Martin and Sarah Hardie for the text and photos. Thank you for all the kind words of support for my first edition in February - I’m still on a bit of a learning curve so apologies if anything was missed. You’ve been sending in fantastic articles and pictures - it’s great to see what everyone has been doing ‘out in the field’ and the enthusiasm you continue to show even after lying on a cold floor for several hours! This resilience and camaraderie is something that really attracted me to CU in the first place - it is a great organisation and we are fortunate to be involved. Branch Leaders - look out for the regular email I send out to you to prompt you to ask the members for possible interesting articles. Thank you for the great articles and photos you’ve been sending for the magazine. Please keep up the good work by sending me anything you’d like to share about exercises you’ve attended, events you’ve been to and of course, any hints & tips for make-up & acting realism. It’s great to have photos with these articles so anything you can send will be appreciated whether its taken on a ‘real’ camera or your mobile phone. If images are too big to send by email I can advise an easier way to send them. If you have some great prints of photos we’d love to see them and you can send them by post with a SAE so they can be returned. I can accept your articles in Word Doc, Apple Pages, Google Docs, WPS and email, in any font or size! If you don’t have access to a PC why not ‘dictate’ an article to a fellow member. Send your articles to: Any material submitted must have the full permission of the people concerned to edit and publish said material. Credit must be given to photographers and writers of original work where required. Copyright must be obtained before material is submitted. It is the responsibility of the sender to obtain such consent.

An apology from the Editor In editing an article in the Feb edition of the magazine to make room for a last minute article I accidentally deleted a special thank you to some of our members in the London Branch and got a slap on the wrist. Lucy Macleod-Cook, London Fire Brigade’s Trauma Team Manager, wrote these generous words of praise about our members who spend so much time helping them practise: “We would not be World Champions for 2018 without the help of our lovely friends in Casualties Union, in particular Marian Kerr, Jean Fitch, Jim Goodwin and Sarah Martin, with the occasional appearance of long-standing ‘casualty’ Caroline Thomas.

We have another action packed edition this month along with the ITW being featured we have articles about some of the interesting exercises you’ve been attending in the past few months. Thanks for the response to my request for suggestions for the title of this particular segment, some of these included: Quiet Russlings Russling leaves What’s all the Russ about? Russ and nonsense Russelled up earlier (Thanks Jenny & Caroline)


The Furness Branch Royal performance by Paul Fones The day after we returned from ITW we had a very special assignment. HRH Prince Charles was to visit Langdale Mountain Rescue in Ambleside and we were asked if we could help them out with a scenario. This was so that HRH could see for himself the team in action as they worked on me. HRH then met Andy, Barry and myself along with the mountain rescue teams. I was also interviewed for BBC Radio Cumbria. There are more Pictures on the Langdale Mountain Rescue Facebook page if you want to see them treating me in front of HRH. CASUALTY SIMULATION 05-19


Responding To Urgent Need Jim & Maggie Beed

All over the country ambulance services are frequently stretched to the limit. So, what can be done when a 999 call comes in and there are no paramedics available to attend? Calls are prioritised according to their apparent seriousness, but some will have a long time to wait. One answer is ‘First R e s p o n d e r s ’, l o c a l volunteers who can be called out from home or work to attend. They are especially needed in remote places where an ambulance will be a long time getting there. There are many ‘Responders’ all over the country and Mike Holden is one of them. Mike came to a C.U. training morning to talk to us about what is involved and brought his kit with him. A heavy bag, containing all that you would expect in a first-


aid kit plus a defibrillator. In a separate bag he has an oxygen cylinder for patients with breathing problems. When his kit, which he shares with two other responders, is not being used by an on-call responder it is kept very safe, at Lympstone Royal Marines Commando Training Centre, where one of the responders is based. Mike also has a pager to tell him when he is wanted and a phone to contact Ambulance Control. On arrival at an incident he has a check list to record what he finds out about the casualty. He can give treatment b u t n ot d r u gs o r medicine. Once he has done everything that needs urgent attention, he then must wait for an ambulance crew to arrive. Only Ambulance Control can decide to stand down the ambulance if the report that he phones to them indicates that one is not needed. Training is given of course,

CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

but after many years in the St John Ambulance Mike is well versed in first aid. His area of operation should be within three miles of his home, but often he is called on to go to towns and villages further away than that. There is no payment, even for petrol. He had many tales to tell about incidents that he has attended. A caller with ‘chest pains’, who pointed to his abdomen when asked to show where it hurts. There was the call when there was no electricity because the meter had run out of money. After managing to get some cash and insert it, it was still no good. An electrician came but could not get things going again. Later Mike found out that there was a button on the meter that had to be pressed for ten seconds to get it to work. One woman was surprised when he arrived. She had only phoned in to ask where she could get some medicine that had been prescribed. A surprising number of people call an ambulance rather than go to the doctor. In an area with a more elderly population then

usual there are many calls to people who have had falls. Once they have been checked for injury the problem is how to get them up again with only one person to lift them. Mike has a bag with a gadget in it to deal with that. It is called a ‘Raizer’. To start with, an item like a scoop stretcher is placed under the casualty. Other bits are added, and an electric motor raises them up. First to a sitting position, so that they can be moved on to a chair, or brought completely upright into a position where they can walk. We

all had to have a go on that! Not only a very interesting training session but plenty of ideas that we could use in an exercise where it would fit the scenario.

WELCOME TO NIAMH Caroline Thomas

This is Niamh O’Shea, who joined London Branch a year ago. She is now 21. Her Irish first name is pronounced Neeve, and she can dance Irish too! Caroline Thomas takes her new trainees to classroom events such as this First Aid at Work course, where a CU member attends for two hours on the last day. They present a variety of medical and trauma scenarios for a pair of students to work on while the others watch, followed by a very useful discussion on how it went and what could be improved. Her trainees act as anxious relatives while Caroline has a heart attack, a stroke

and a seizure. She gives them the injuries to present and they have a go at doing the make-up. For 15 years STS have used London Branch several times a week. Originally they were there for the students’ end-of-course assessments, but when FAW courses had the trainer assessing throughout the course, while some organisations said they no longer needed CU, the more enlightened STS continued to bring them in as part of the training. You can imagine how this fine-tunes their skills, improves communication and gives them confidence. This is what Niamh says about her

Here, Niamh has presented a fractured forearm and is being treated while the trainer, Mary King of STS First Aid, watches carefully.

early experience with CU...

“It was through St John Ambulance that I first heard about Casualties Union. I was asked to act as a casualty for a Medical Response Team training day in March 2018 which concluded with a major incident. It was interesting to be on the receiving end and observe how we as first aiders approach and treat our patients, from our body language through to the tone of voice and

the words we choose. Since joining CU I have realized how well first aid and casualty simulation complement each other. While out on a St John duty I can now recognize conditions much more quickly, because I have had to study the condition I am acting in great depth and detail. Conversely, when I am acting I can draw upon my St John experiences of seeing patients and try to recreate what I saw to make the scenario more realistic.”


When I offer overnight accommodation to a friend, the spare bed they sleep in shares a room with assorted cupboards, wardrobes, chests-of-drawers and shelving concealed by curtains. The labels alone intrigue them: PALLOR, PUFFERS, SKIN, BRUISES, BLOOD, BURNS . . . so it’s hard to resist the temptation to peek behind the curtain, and that’s when they get a close-up of the tools of my trade: assorted containers labelled: HANDS & FINGERS, PSORIASIS, BEE-STINGS, VEINS, INTESTINE, VOMIT. Their clothes must share a wardrobe containing a shirt with a blood-stained stab-wound. Part of the wall is covered by an enormous map of London bearing red dots here and there; these mark the location of my members’ homes, so that I can easily organise logistics for the out-of-town trips by cars and minibus, such as the annual Eurotunnel emergency exercises. As my IF YOU HAVE A SIMILAR ‘CHAMBER OF HORRORS’ PLEASE LET US KNOW

guest moves shakily to the door they find hanging on it a multi-pocketed contraption containing spatulas, cocktail sticks, old watches, artificial teeth and --- oh, horror! a false eye, the same colour as Caroline’s. The thought of moving to a local hotel passes through their mind, but those who know me well realise it’s all for a good purpose, and a copy of our magazine for bed-time reading explains everything, without necessarily guaranteeing a good night’s sleep.



News, Photos and Videos…

It’s as Simple as That! Sarah Martin - London Branch

It’s been a while, but I’m back for another update. 2018 has been a brilliant success for Casualties Union with an increase in volunteers and our name being out in the media more; this was only achieved with your help! In terms of numbers you will see from our statistics below we have started to build up some great interest in our charity; additionally, our Do-It page has also seen a continued influx of new volunteer enquiries! We expect that by now PLATFORM FOLLOWERS you would have probably seen us on social Facebook 451 media by now but if you don’t have access, Instagram 219 perhaps you can ask a friend or family member Twitter 259 to show you by searching ‘Casualties Union’ on Facebook, Instagram or Twitter! We hope that what you see on there is engaging and also informative; we are always after new news (it’s difficult to show recognition and showcase Casualties Union when there is nothing to write about).

Some creative dates for the diary

The news we share doesn’t always have to be about the seriousness of the volunteering we do. It would be great to share stories about why you volunteer and show why it is enjoyable.

Want to get creative and get involved as a member / branch - here’s some ideas: National Volunteers Week 1st - 7th June 2019 (celebrate what you do, have a training evening on this week, congratulate a fellow volunteer on the work they do) Friday 21st June - National Selfie Day! (join in the fun and send us a selfie with your best Casualties Union make-up look - messy or realistic, before or after being ‘treated’) 5th September - International Day of Charity (help us celebrate Casualties Union at it’s finest) News, photos and videos… it’s as simple as that! Are you arranging, or already at, an event such as a conference, exhibition, open day or emergency services day? Tell us! We love to spread the news and promote the work that you do; especially when those you are working with are already promoting the event on social media. With their help we can build up a calendar of events. 6

CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

Events, created by their organiser, appear like this on Facebook. We can then add it to our own list to say that we are assisting!

Feed Us With News! In 2018 we jointly promoted 8 events from trauma and university conferences to emergency services fun days. 2019 events already include the Emergency Services Show at the NEC (September 2019), KCLWMS Conference (February 2019). Are you going to event which is not listed but you want to get Casualties Union social media involved then all you need to do is get in touch! Additionally you can take photos and share the day with us! Did you know that all we need to get started is one photo and an accompanying two sentences?

Topics can include: • • • •

A casualty point of view, The challenges of make-up, Team-working Any other aspect of our volunteering world as casualties.

You can send pictures and text to: Or get in touch with our Facebook page by sending us a direct message!


What is a Hashtag? What do they do?

Hashtag entered the dictionary in 2014...

noun. (on social media websites) a word or phrase preceded by a hash mark (#), used within a message to identify a keyword or topic of interest and facilitate a search for it. A hashtag is a tag used on social networks such as Twitter and Instagram, allowing users to easily find messages with a specific theme or content. The hashtag may contain letters, digits, and underscores. Searching for that hashtag will yield each message that has been tagged with it. A hashtag archive is consequently collected into a single stream under the same hashtag. For example, on the photo-sharing service Instagram, the hashtag #casualtiesunion allows users to find all the posts that have been tagged using that hashtag.

This post was shared to 484 on Facebook and did a lot to encourage people to engage with our social media sites!

*NB: We are aware that some events or duties are ‘sensitive’ and we may get in touch with branch leaders / regional directors to confirm whether such duties, or events, can be disclosed to a wider audience. If you are not sure what you can share, perhaps just take a photo or video of a volunteers make-up without any identifiable information about the location or exercise; this way we can still use it! Additionally, always ensure that you ask permission before taking photographs of other people!

VISIT • LIKE • SHARE • COMMENT casualtiesunioncharity CasUnionCharity casualtiesunion CASUALTY SIMULATION 05-19


Research & development by Reading Branch in the use of Cinematic Grade Silicone makeup and how we gained new members from that research. Alan Prior, Branch Secretary – Reading Branch Following the excellent presentations on silicone makeup and lifecasting at the International Training Weekend from both the Furness and West Mercia branches in 2018, I took what I’d learnt back to Reading branch for the other members to see what was now achievable. In certain areas like Silicone glass – the technology was welcomed with utter delight and amazement. I was told that they had literally searched for years for a solution to having realistic looking glass that was safe. However, in the area of silicone makeup, this was met with less enthusiasm and statements as to why it wouldn’t work as a replacement to traditional dough makeup. There were lots of questions about the cost and ease of production, but ultimately I felt that most members were not keen to stray away from the tried and tested dough makeup. I had shown them examples of lifecasting a finger using alginate and plaster, and although they were generally interested, nobody could think of a realistic use for it. However…. One of the key advantages of 8

silicone over traditional dough makeup is that it is not compressible. If you put a dough wound on someone’s back and they lean against a wall, then the dough gets squashed, and you need to start again, so there is no resilience to the makeup. With an equivalent silicone wound, it will not shift once glued in place, and you can lie on it all day, and it will not change shape at all. Of course, with our core work of ATLS / ATNC, there is no requirement for a resilient wound as most of the injuries are there to “look at”, the casualties are laid on a bed and so their bodies are used as a canvas to paint the injuries on. As they are still the injuries only need to stand up to being poked and prodded rather than being too robust, hence why dough with cloth and 50/50 is an obvious and cheap choice. So the question arises – what could we use silicone for and are there elements within the ATLS that we could use it for? I was tasked with further investigations into Silicone makeup and in what situations it could be used. Personally, some of the

CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

wounds that I find difficult to do in the ATLS are head wounds and mid-thoracic stab wounds. The reason being is that injuries to the forehead are difficult to place if your model has a full head of hair and using 50/50 and cloth near to the eyes is potentially dangerous. The mid thoracic stab wound is difficult to place if your actor is female as the edge of the wound abuts the lower edge of the bra, and as this area is a skin fold area, movement of the body can dislodge the wound if dough and cloth is used. I turned to the internet to do some initial research on how to go about creating wounds in silicone. I’d watched numerous YouTube videos and read many articles. One name, Neill Gorton, kept cropping up. Neill produces instructional DVDs on the subject, and I managed to get hold of a couple to learn the techniques. Neill, I was later to find out, owns a company called Millennium FX and their key contracts, includes producing the creature effects for Doctor Who. Although I was unaware at the time, the method I was

learning was cinematic grade silicone prosthetic makeup. Essentially the process of production of a silicone wound is not dissimilar to modelling in dough. When using dough, we get a small amount, match it to skin colour, cover it in cloth, bond it to the dough, and the skin then create an incision and fill it with blood. With the silicone technique, you first create a model in clay, then create a mould of that in silicone. You then coat the mould in an encapsulate and make a silicone copy of your model from the silicone mould. Demould

the encapsulated silicone and then bond this to your actor, blending it to the skin colour. The picture below shows the 3 stages of Clay model, Silicone cast and prosthetic transfer appliance.

a silicone model and sticking this to the skin and all the way through to cinematic level, flat mould, silicone prosthetic appliance makeup - the method that Reading Branch are currently using.

There are many ways that you can model in silicone; From direct application to the skin (using sculpt gel or skin sculpt), making

While we were developing these techniques, we were coincidentally invited to do a demonstration at a local college to students

There are several advantages of modelling in clay first rather than directly modelling using silicone: 1. Minute detail can be added to the clay. Things that you would normally see such as lines in skin, skin pores and even scars can be added. To make a cast from a mould already made from silicone we have to create a barrier between the two parts using a chemical called an encapsulate, Encapsulate is essentially a vinyl dissolved in our old friend, Ethyl Acetate and once dry creates a stretchy, rubbery film as thin as cling film. It is the encapsulate that acts like the cloth we would use in a dough based makeup and holds the makeup in place. Because the encapsulate is made from vinyl rather than silicone, to glue the appliance to the actors’ skin we can use a cheap industry standard glue called Pros-Aide rather than having to use more addition cure silicone. 2. Once the mould has been made then reproduction of prosthetic transfers is relatively cheap. A 50mm stab wound costs no more than 30p in materials to make. Although silicone can be reused, making a new wound for each application negates any hygiene risks. 3. By adding detail then, close up, it is not easy to identify what is skin and what is silicone. Using detail, you don’t have to drench the makeup in blood to cover up an obvious smooth silicone surface. 4. Another advantage to using an encapsulate is that blending of the edges is very easy as encapsulate dissolves in isopropyl alcohol (IPA), so working around the appliance edges you can use a cotton bud dipped in IPA to “melt” away the edges. Additional colouring can be achieved with alcohol activated paint or an airbrush or your existing water based colouring. Below is an example of a silicone stab wound that we cast and applied to the actor. Time wise it took about 1 hours work to cast ahead of the event and about 2 minutes to apply “on scene”.

also showed some of our early experimental work in silicone prosthetics which caught the eye of a couple of the students interested in Special FX. One of the students (Katie) started coming along to our Branch meetings with her mum, and both of them have joined as trainees. who were studying a City and Guilds in Makeup Artistry which included a portion of Special FX makeup using silicone prosthetics. As part of their course, the students are required to do work experience training with local employers, but although the course is aimed at students looking to do Wedding and Prom night makeup, there is a small niche of around 30% who are looking to work in the area of Cinematic and Theatrical Special FX. In that area the students have little to no chance of working in a film studio without being able to show a decent portfolio of work, so where do they start?. Our local college had Googled special fx and apparently stumbled across Casualties Union by accident (like many people, they’d never heard of us). On the day, we did a demonstration of an open wrist fracture using dough makeup but

Through discussions with the college, we were able to offer her work placement by helping us with ATLS and going out on exercises. As part of our CU membership, we build our own portfolios, and because we are increasing our knowledge and skills on cinematic grade work, in turn, she has been able to pick up industryspecific knowledge as well as creating a portfolio of her own. We may in the future be taking on more students looking for work experience as Theatrical and Special FX makeup courses are a growth area for local colleges (given our relative proximity to Longcross, Leavesden, Pinewood and Elstree studios). In turn, this helps us to attract much needed younger people into our organisation. If you’d like any further information and or a step by step guide, email us at CASUALTY SIMULATION 05-19



SPRING-SUMMER 1969 Caroline Thomas

This was a two-season publication because the Editor, Helen Nicholson, had to give priority to looking after a close relative. It was missing from Headquarters’ collection, but captured digitally by Steve Cochrane on our visit to CU’s archives at the Wellcome Institute last year. The front cover is a happy group of Conference delegates at Nottingham University. 40 people attended, though some for only one day. Look at the front row of people sitting -- fourth from the left is our recently retired Chairman Mary Jacobs. Next to her, with head turned to the side, is former Hon. General Secretary Mary Murphy. The delegates enjoyed a lecture about burns by Mr Wynn-Williams, a Nottingham Surgeon, illustrated by a member’s make-up, which he said was perfect realism. Praise from the top medical experts is praise indeed. They learned what happened to a patient with a severely shattered leg from admission to A&E through to physio-therapy and rehabilitation. There was a lecture on ‘how to give a lecture’, though some of the members who were 10

teachers clearly had issue with the recommended methods. An open forum made the point that, when we act minor injuries in a multi-casualty situation, we should not just sit quietly, but talk to fellow casualties, rescuers and first-aiders in a natural manner – something to practise at training meetings. Members agreed that make-up for closed fractures of collarbone, wrist and ankle did more harm than good, as it so often looked like make-up and would be better portrayed by acting alone. Mary Jacobs wrote an article called ‘Country Cucu’, explaining that she had moved to Gillingham (Dorset) three years ago and, being a nurse, worked part-time for the local ambulance service. An ambulance man invited her to help him set up a CU Study Circle and she was its Secretary. They would practise at Mary’s house, and she often answered the door with a wounded arm or pale, sweaty face when people called to ask her doctor husband for assistance. It took a while for the local community to get used to Mary’s new activity. Being in the country, Mary found that cow udder cream was

CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

cheaper than Vaseline. She cadged embalming wax from the local undertaker for wounds near the eye, nylon stockings from the W.I. members, sausage skin and bones from the pig factory. North Staffs. Branch recalls that, when Don was acting fractured pelvis on a railway track at a colliery, he was carefully splinted and tied to the tracks. Kay Harris had a hand in her mouth trying to extricate her false teeth, but it didn’t work, for they were her own. I have seen a member acting fractured arm fixed to the chair he was sitting on because the sling encompassed the chair-back. After articles on circulatory disorders and advanced staging techniques, we read of the introduction of CU’s diagnostic tests in which the

first aider must not touch the casualty but look, ask questions and listen carefully. These later formed part of our annual competitions for first aid teams. N otes for younger members and how to act with your hands are followed by a report of one of the first major disaster exercises CU had done. Mary Jacobs found it a lot of work to organise her members for it, but she found time to produce a questionnaire for everyone involved in the rescue and care of the casualties. It was a feedback form but also explained how they can contact CU for future events. As a result, Gillingham (Dorset) Study Circle was overwhelmed with requests. Mary, you were a pioneer in Public Relations as well as making use of bits of pig!



In this picture I am seen using one of my range of scanners, an OpticBook 3600. Scanning printed material in any quantity requires specialist equipment and software. The OpticBook is now quite old but still available cheaply on Ebay. The picture shows how an open book hangs on the edge so that scanning extends into the spine of the publication without damaging it. Quality is good and lighting even but the output is only about five pages per minute. A much quicker piece of equipment, although more expensive, is the Czur ET16 which operates as an overhead camera and includes very clever software that not only produces a small PDF file but effectively crops pages and “flattens” their curvature too. Unfortunately the Czur does not reproduce glossy surfaces well but a new model, for which I have high hopes, is imminent. The Czur’s main advantage is speed - up to 30 pages per minute; the limiting factor is often the turning of the pages. In reproducing the Casualty Simulation archive I have used both these pieces of equipment. The Wellcome Library does not allow scanners, even those which involve no contact with the pages; as a result I had to use my camera phone in London. I do not pretend that these issues are consequently reproduced as well as scanned ones, but they are at least legible. The result is a collection of files covering the entire history of our magazine. The PDF files are easy to consult and search - much easier than a collection of loose magazines such as Casualty Simulation.

FAST RESPONSE... Within weeks of Steve working through and scanning some of the really old magazines an enquiry came through from Australia asking for information about a St. John Ambulance member named as Mr. Dymond who founded the Melbourne Study Circle. Before this, I would have had to trawl through dozens of old issues looking for references to the unit, but Steve just had to instigate an electronic search with the key words, ‘Melbourne’ and ‘Dymond’ – and there they all were! He emailed them to me in four batches and I forwarded them to the enquirer. His reply was, “ Your responses have far exceeded my expectations and they will make a great addition to our museum file and to the story of Bob Dymond’s St. John history. Caroline Thomas.

I enjoy being a member of CU immensely, but have a couple of questions perhaps another member could help with relating to a recent ATLS course. 1. Why is it that someone wearing surgical gloves always manages to pull out a few chest hairs with each shirt button that they undo? 2. Is a small fridge supplied for students to rest their hands in for a few minutes prior to examination? 3. Lastly, I am the proud possessor of a sternotomy scar down the centre of my chest (obviously). It is always explained that this plays no part in the moulage, but this never stops the students from lazily running a finger down it at the end of their test. Answers on a postcard please. REGARDS, JIM JEFFERIES (North Staffs)

Steve Cochrane. Trustee/Stour Branch



INTERNATIONAL TRAINING WEEKEND Report by roving reporter, Sarah Martin

2019’s international training weekend was another fantastic success with some very thought-provoking presentations, interactive workshops and, as always, recognition of the excellent voluntary work by our members and branches. It was a privilege, as your roving reporter for the weekend, to be there taking photos! For those who couldn’t attend I hope you’re able to take away some snippets of information from the below highlights, and those who were at the ITW, I hope this is able to serve as a recap of events for you!

The talks The first talk of the weekend was made by Justine on psychoactive disorders. Her presentation gave us a first hand account of the signs, symptoms and effects received by someone with schizophrenia and bipolar disorders. As an individual, with social anxieties, Justine’s was able to provide a confident and personable insight into how mental and physical health is linked; advising that those with mental health issues are three times more likely to have a respiratory disease and four times more likely to have diabetes! Her choice to conduct a talk on such a personal subject enables our volunteers to add an ‘extra layer’ to the casualties we are asked to portray advising that “8 to 10% of people have a mental illness… so during an exercise of 30 casualties up to 3 may need to portray such issues.” Her own, personal, key indications of a psychoactive disorder include hearing voices, hallucinations, extreme moods; thoughts of self-harm or suicide are not things she thinks but is aware of other friends who do. Justine’s very prevalent opening line to the presentation was: “whatever normal means” … i.e. the meaning of normal differs for us all! 12

CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

Our second talk, by Adrian Sawyer, a lecturer at Plymouth University, gave us an excellent insight into the realities of terrorism; something that is becoming more frequently in our modern lives. Members were introduced to the varying scale of terrorism; from extremist views about politics or religious subjects to the willingness and precedence with carrying out an attack based on those views. Using footage from the Boston Marathon bombings, accompanied by a presentation, Adrian introduced members to the specifics of mechanisms of injury in relation to bomb blasts, as well as other current terrorist methods (knives and vehicles). With explosions, Adrian explained that there are three parts to a mechanism of injury: primary, secondary and tertiary. Primary injuries from such events are caused by the pressure wave from the blast hitting the body and having an effect on internal organs; specifically, oxygen generating organs and the GI tract. Secondary level injuries are as a result of shrapnel or other objects that, unfortunately, would penetrate the body and cause serious bodily harm to organs which may not be visible from outside. Finally, tertiary mechanisms of injury would be as a result of the propelling of an individual to another location from the blast, resulting in additional injuries when falling to the ground or hitting other items of infrastructure. Adrian discussed that there has been a move, over time, to more simpler methods of attacks (using knives and vehicles) each of which have other expected injuries. It is always worth asking the exercise organiser, if this was the scenario, the exact simulated method used, and weapons involved.

Photos courtesy of Sarah Martin & Sarah Hardie CASUALTY SIMULATION 05-19


The workshops Members were able to attend three fantastic workshops on various subjects. Unni Gran, from Norway, demonstrated some simple, yet effective, techniques for make-up using silicone and other useful products. I personally was surprised by the ease and effectiveness of creating a flash burn using only blood and black hair colouring spray! This provided some excellent results that could easily be replicated on many other casualties in a short space of time.

In addition to Unni’s brilliant demonstration, there was a workshop on conducting risk assessments and understanding the Health and Safety principles behind attending exercises. Richard Piper and Graham Liles made sure that this wasn’t a boring presentation and members were asked to conduct a risk assessment of the area outside as if it were an exercise. It was great to see small teams working together to achieve the same result; sharing knowledge amongst those who may not be so au-fait with Health and Safety regulations and risk assessments! Last, but by no means least, James Coomber of Avon Fire and Rescue gave an intriguing presentation on attending collisions from the perspective of the fire service; how they deal with the scene and casualties. James explained that on arrival, crews must ensure that they conduct a complete check of the vehicle(s) involved


CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

for hazards such as hot surfaces, unstable items, fuel and undeployed SRS systems; all of which could cause further injury to attending emergency personnel as well as the casualties inside the vehicle. Many volunteers have not been extricated from a vehicle before and it was useful for James to explain some of the key steps taken from arrival to the collision to extrication of the casualty. James, using a video from NCAP, a vehicle testing agency, demonstrated to volunteers how vehicle safety has changed over time; which as a result has changed the injuries seen at incidents.

Other bits West Mercia branch had another successful shop open and there is also now a new trophy that can be given out at each ITW for new competition held each year. The evening dinner on Saturday was also a success with some excellent themed fancy dress and many a smiling face! Well done to all the organisers of this year’s outstanding ITW Richard & Bev Piper, Graham & Sarah Liles and Fleur; I hope to see you all again next year!

PRESENTATIONS MADE LOTUS TROPHY awarded to the Branch demonstrating the greatest achievement in striving to further the objects of Casualties Union: FURNESS BRANCH JOHNSON CUP awarded to the region that has demonstrated the greatest efficiency in relation to recruitment, training and administration: REGION I (NORTH WEST) JARVIS TROPHY (VICE-PRESIDENTS’ PRIZE) awarded to an individual member for enthusiasm, commitment , dedication or other quality considered worthy of recognition: JENNY FLETCHER (FURNESS BRANCH) HONORARY LIFE MEMBERSHIP Barry Robinson (Furness Branch) EXEMPLARY SERVICE MEDALS (15 YEARS) Patrick Carney -- recently retired, was in Stourbridge Branch Margaret Holmes -- West Mercia Branch Geoff Tickner -- National Branch Helen Coppenhall -- North Staffs. Branch Steve Coppenhall -- North Staffs. Branch) EXEMPLARY SERVICE MEDAL CLASPS (25 YEARS) Fredda Thickens -- Wessex Branch, formerly Wessex (Wimborne) Dinah Auton -- Bath Branch Ronald Auton -- Bath Branch Janice Waspe -- Ipswich (Stour) Branch EXEMPLARY SERVICE MEDAL CLASPS (50 YEARS) Stella Chapman -- recently retired, was in Gillingham (Dorset)



DISASTER VICTIM IDENTIFICATION Tricia Summers, Regional Director F, met a police officer on an exercise to train police in recovering fatality victims from open spaces. He told her about a big national DVI conference to take place in March at the Guildhall, City of London, and that he would like Casualties Union to display photographs and publicity leaflets in the lunch and coffee-break area. Tricia jumped at this publicity opportunity and contacted Caroline Thomas in London Branch. The organiser was Howard Way, for whom Region D do a lot of work for police DVI training, both in ‘recovery’ such as being lifted out of the stands at a football stadium, and in ‘strip-search’ on the mortuary table. Caroline packed her display stand, including Russell’s new Event Poster and a photograph of CU in the police mortuary tent at Exercise Unified Response in 2016, a bundle of Year Books and a special leaflet she had designed advertising our DVI skills for police training. It shows photographs of CU members acting our role on the mortuary table and explains how we are happy to be ‘recovered’ from the incident scene, then undressed and photographed in the ‘mortuary’ classroom, that we lie still and only ask two things: that we may keep our swim-wear on and be kept warm! We set up in the beautiful Old Library at the Guildhall, bringing back distant memories for Caroline of being a Bulgarian-speaking casualty with fractured clavicle for a Red Cross competition. In coffee breaks and for the lunch hour it was heaving with police and we chat-

We are the volunteers at this event who make first-aid and rescue training realistic

Find Casualties Union on Casualties Union • Registered Office: P.O. box 1942,London, E17 6YU, UK • Registered Charity number 234672


ted non-stop about our work, answered questions and handed out the leaflets and year books. We spread the leaflets around the enormous room by putting a few on each table where the delegates stood chatting with their coffee cups. The First Aid Nursing Yeomanry (FANY) was there to hand out delegate packs on arrival, and invited Caroline to give a talk and demonstration about Casualties Union. We talked about our work to police from all over the country, and Coroners’ office staff. We were surprised how many had never heard of CU. Even the caterers took an interest.

Tricia and Caroline, both on CU’s Publicity & Media Panel, found the day worthwhile as an exercise in reaching out to a specialist group, using a tailor-made leaflet supported by our standard publicity material, and attracting attention by carefully chosen photographs on the display stand. Smiles and enthusiasm do the rest.

Here is a closer view of the poster mentioned above. It is A3 in size and gloss laminated to give a bit of protection when displayed at events we attend. It’s a great way to promote ourselves whilst ‘on duty’ and lets other participants and members of the public know who we are and why we are sitting in that muddy puddle with a bloody nose!

CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

UPDATED CU WEBSITE Please visit and inspect our brand new website. Thanks and congratulations go to Joshua Piper, Richard’s son, for his expertise in turning Caroline’s design and text into a proper website. In the future we hope to have video clips on it, as we did before, but Joshua is a very busy student and has not yet been able to achieve this. Your suggestions for further improvements will be welcome. Email: Caroline at

Rock n Roll ... but not as we know it!



Exercise Hagion, a Restex attended by members from Region F. A tanker with an inflammable load on board had just smashed into a bridge and damaged some houses. Toxic fumes had escaped, and the surrounding houses for a wide area around the crash had to be evacuated. People needed somewhere to go, be fed and their needs and fears addressed. What does the Emergency Planning of a local governing organisation need to do? Organised by the Emergency Planning officer from Devon County Council Exercise Hagion was to test the response of Devon County Council, the local Councils in the area, their various departments, and the ability of voluntary organisations to assist in whatever situation was likely to arise if a disaster happened “for real”.


Planning began some months before and involved several meetings. They were attended by all the leading organisations taking part including staff from the local Teignbridge and Torbay Councils, those managing both the venue and the caterers, Police, St JA, Red Cross, Salvation Army, Devon Faith team, and Casualties Union. Our input was well received as most of the ideas for acting and minor injuries proposed by us were used in the exercise. On the day about 200 people arrived and had to be accommodated, looked after and kept calm until the all-clear was given. Many departments in the Councils were being tested to make sure they were competent to deal with any of the requirements of a diverse set of worried people.

CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

Also, there were VIPs, the press and local TV to be given updates and allowed to talk to anyone and film the event without compromising the exercise. Apart from the general worry about not knowing what to expect, and how long before people could return home, Casualties Union provided some specific acting and injuries. Peter Edwards (95 years young and acting emphysema) blossomed amid a bevvy of young StJA female staff as soon as he arrived, and Council staff did stalwart work dealing with Sue Joosse and the challenge of her pet snake. Alison Hughes did such an excellent job of acting grief for a dead relation that the staff Though it was not part of the exercise. A wheelchair-bound Peter Hine and Elaine made a lot of demands for Peter’s condition and the space for a wheelchair, and Elaine also had her purse pinched. The police took a lot of convincing that they had to find it as their first response was “This is for disaster evacuation, not one for robbery”. After much insistence, they did take the report seriously and

eventually apprehended the “thief” and returned the purse. Barbara Baxter was a Muslim who needed a quiet place for mid-day prayers, and Jim Beed was anxiously trying to get away for a wedding abroad, but his passport was at home in the cordoned off area and his plane was due to take off that evening. Anne Greek, in a fetching pink dressing gown and slippers, had dementia and eventually managed to give her friend, Joan Goodman, the slip and hid. This caused a frantic search by many staff and Police requests for help to find her. She was eventually found in one of the loos. Cynthia Matthews and Carol Tuckett acted a couple who required accommodation together and also had to deal with “personal” problems involving wet clothing! Joe Greek made a great nuisance of himself by refusing to give any information in case it was passed to the police. He needed to contact his partner and would not use the public phone and kept demanding a mobile instead. In addition, John Cann came out of retirement from CU and gave a master class in developing the role of a homeless drug addict who happened to be

“resident” in a shed at the time of the incident. He managed to get a night’s B&B, a promise of a flu vaccination at the chemist’s, a travel pass, replacement specs, had some food vouchers provided and his methadone sorted, all of which took most of

the exercise to sort and kept one member of staff always on hand dealing with him. Derek Earl acted an exemplary heart attack attended by his worried partner Shirley Cope and provided StJA with plenty of practice. This was televised and was on both the

evening and following morning local Spotlight news. After talking to the journalist doing the interviews and explaining about our charitable status, Casualties Union also had a specific mention on the evening Spotlight.

Most of the issues were dealt with well, and some areas of response will be improved following our role play and subsequent feedback. Generally, a worthwhile exercise, plenty of publicity for Casualties Union – and the food was excellent!

30 Metres U ndergroun D Marian, Jean, Alan, Jim, Sarah - London & Welwyn Garden City Branches

The story starts: “in a dark, dark town there was a dark, dark street, and in the dark, dark street was a dark, dark house, and in the dark, dark house there were some dark, dark stairs…” Well that’s if you were reading a chapter out of the Funnybones story books! For five of us, over two days, we were 30 metres below London in Clapham South’s deep tunnels; once used as a subterranean shelter. Normally, Casualties Union duties don’t present any ‘major’ challenges to us in terms of make-up, however, on this occasion, we were faced with creating difficult make-up, in a dark environment with only torch lights to aid us; and that’s when they were still working! The scenario was a mining incident, whereby some employees had become trapped under fallen debris whilst two others had made their way to safety of a chamber; only to start running out of air. Our make-up ranged from simple signs of hypoxia to an open, broken tibia and an impaled thigh! Cue a few hours later, and several visits from the London Fire Brigade and HART teams, we were ‘rescued’. Needless to say, that on the second day, the lift between ground level and the mid level shelter broke down, resulting in emergency crews having the added issue of 180 steps to walk down with equipment and breathing apparatus sets! It certainly took some skills and creative thinking to create the realistic make-up in-situ in the dark tunnel; but the responding crews were very happy with the results and hope to use Casualties Union again this year! CASUALTY SIMULATION 05-19


Furness ‘BRANCH’ to the rescue It was on the Sunday in late February that turned out to be a beautiful spring day when three of us from Furness Branch joined Kendal Mountain Rescue for a day of training. On arrival we had the excitement of observing their winch training with the rescue helicopter. It was an amazing experience to see the helicopter at such close proximity and feel the sheer force of the down-draft. Unfortunately on this occasion we weren’t involved in this part of the training but it was great just to watch the team in action. Following a brief fractured wrist exercise with the team we got ready for the ‘main event’ of the day - the brief was that we had fallen down a hillside and landed on something that had impaled the abdomen. The brief was a bit vague as to what the impalement should be - the issue was that we needed something that would be found on a hillside, but that could be simulated as an impalement, and be held in place for the duration of the exercise and be robust enough to withstand writhing, close examination and casualty extraction. In the end we opted for a plastic shelf peg with a flat base that could be painted to look like a rusty spike. The base was covered with liquid latex to simulate the puncture wound and to allow purchase of the wound. The end result was very effective, and had the desired effect and robustness required. 20

CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

H owever when the time came to prepare for the extraction exercise the organiser informed us he’d like it to be a broken branch that had been impaled... What would we do? The team (i.e. Caitlin and Elaine) sprang into action and located a suitable broken branch then we cut a groove in the wood and fixed it to our ‘metal spike’. It worked, giving the desired impression. We got into position (at the bottom of a riverbank) and waited for the team to locate us. Kendal Mountain Rescue were using a heat seeking drone for the first time to aid in this rescue and it soon located our position. The team quickly arrived and the extraction took place - although I think it took more people to drag my stretcher uphill than Elaine who was portraying the same injury further along the bank. It had been a great exercise, a nice day and on-location whittling practice!


WEST MERCIA At the Annual General Meeting of West Mercia Branch in January, Branch Leader, Frank Smith, retired and handed over the reins to his Deputy, Geoff Dellbridge. Geoff asked Simon Ip to be his Deputy who would automatically step into the Leader’s roll when Geoff relinquishes control. Anne Adams remained as Treasurer. The day was scheduled to be a Training Workshop as well and Area Director Tony Peake and his Deputy Judith Ward joined the group to conduct Member Level assessments on five members. One couldn’t make it on the day but four managed to get through and subsequently became Member Level Qualified. They were Geoff, Alan Lewis, Joan Brazier and Joe MacMahon. Tony also made the presentation of ‘Member of the Year’ to Joan Brazier who shared the award with Simon Ip. The Officers of the branch couldn’t separate the pair who tied with equal training hours, equal duty attendance and both served the branch well in 2018.

Area Director Tony Peake presents the Member of the Year Trophy to Joan Brazier

Make Up Supplies The branch members welcomed the success of our ‘Make Up Supplies’ shop and the substantial turnover should help us in securing better discounts and new accounts in 2019. Silicone use is growing in popularity and a number of CU and BRC members have attended our Joint Workshops during the year to see what we were up to and made purchases to try new techniques. An exciting new account should be opened in 2019 which will improve our make up purchasing abilities and open the way for those branches who have been reluctant to buy new products because of cost concerns. The Branch continues with its association with the British Red Cross in Worcester who provide us with accommodation free of charge in exchange for joint training workshops on Sundays from 10am to 2pm and a snack lunch. Anyone is welcome. Just contact the West Mercia Branch Leader who will provide all details. Scheduled workshops are 28th April, 9th June, 28th July, 15th September, 3rd November, 15th December.

Branch leader Geoff Dellbridge presents Joe MacMahon with his Member level Award

Frank Smith continues to run the Make Up Supplies Shop, orders and enquiries to:



WILDERNESS MEDICINE Every year a conference is held at Guy’s Hospital, London to prepare young medics for handling trauma in challenging and frightening situations such as earthquakes, hurricanes and fire. Staging, of course, has to be somewhat modified in the form of upturned chairs and tables in a darkened training room, but they do their best to create the scary atmosphere by videos of the real thing projected onto a screen, and sound effects. Some

of the delegates were to act as casualties, and six members of London Branch went to supplement the numbers and apply the makeup. Fleur Da Silva had been filming the hurricane at a window when it smashed, and glass shards cut her face and body badly, with many embedded pieces, including around her eye, and becoming hysterical. Niamh O’Shea had an open leg fracture, head injury and lung damage from an earthquake, and Graham Liles in the same scenario had a back wound and a large laceration to his arm with copious bleeding. Caroline Thomas had been pierced in the chest by flying debris and was struggling to breathe. Here are Diane Fisher and Sarah Martin preparing their burns, Caroline Thomas breaking Niamh’s tibia, Fleur pleased with her glass-gashed face and


CASUALTY SIMULATION 05-19 | Next deadline is 30-07-19

Caroline getting psyched up to act pneumothorax. Each scenario was presented several times throughout the day, and we were pleased to offer constructive feedback to the delegates. For many it was a challenge well out of their comfort zone, and a few froze in panic at the sight of our realism, but our pleas for help eased them through the psychological barrier and they did their best to save our lives.

I believe this aspect of our work is more important than whether the dressing is firm enough or the sling is the right way round. Techniques can be practised anywhere, but the ability to control that adrenalin rush and put it to good use needs practice in the most realistic set-up possible and that, of course, is what Casualties Union specialises in.

Extreme Hide and Seek

Ashness Bridge is one of the most picturesque spots in the Lake District, it affords incredible views over Derwentwater and the Lakeland mountains. It was on the hillside near there that Furness Branch members Mags, Jenny, Russ, Penny and Neil were scattered as part of a search, rescue and extract exercise for World Extreme Medicine – the world’s leading provider of expedition, wilderness and remote medicine training courses for medical professionals Thankfully the day was dry as we all had to tuck ourselves away behind rocks, bushes, walls and hole up to wait to be found. We had varying injuries including open fractures, head wounds and lots of bleeding. The rescuers had been given grid references of our whereabouts but no clues as to our actual location. After a wait of just over an hour I heard someone shout “I can see a leg!” Very soon the group of 12 rescuers crowded round to attend to the injuries. For my situation I had an open fracture on my arm which had to be reset in-situ (very painful if it had to be done in reality) and because I had a suspected pelvic injury I had a pelvic strap tied on (thankfully I wasn’t in

need of the loo at this point, unlike some of the others in the group who by now were looking forward to using the facilities so requested their pelvic strap not be fastened too tightly!). The teams did an sterling job in getting us prepared for extraction. This wasn’t to be an easy feat - unlike Mountain Rescue teams, the WEM exercise was to get us down the mountain using whatever materials they had on hand - so no rigid stretchers or medi-vacs for us! My ‘rescuers’ had a large plastic sheet which they folded and placed under me, they then removed their backpacks and used those under me, holding the shoulder straps at either side of me. As any who knows me can testify, I’m not the thinnest of people so it took eight people (inc men & women) to carry me. There was much stopping on the way down to swap sides, swap hands and take five! It wasn’t the most comfortable extraction I’ve ever had but they got me down the mountain in around 45 minutes without dropping me, or cracking my head on rocks so it was a good result. The others all got down safely too, Penny was fed on flapjack on the way down which kept her mind off her broken femur. We finished the day like any good exercise with a hearty lunch at the Derwent Independent Youth Hostel which the WEM had been using as their base for the week. To top off the day we popped into the world famous ‘Apple Pie Cafe’ in Ambleside for you guessed it - apple pie!



the Back Page

Across 5. Abnormal exit of bowel 6. Not the beginning 7. Area of fibrous tissue that replaces normal skin after an injury 8. Composite used to mimic wounds 11. Rigid organ that constitutes part of the vertebrate skeleton 13. An activity carried out for a specific purpose


Down 1. Small medical dressing used for injuries 2. Conducts or order an inquest into the manner or cause of death 3. Small divisions of CU 4. The action of pretending; deception. 7. A stitch or row of stitches 9. CU HQ 10. Fragments of an object thrown out by an explosion 12. Aqueous dispersion of polymers that can be solidified into rubber 14. Annual training event

Don’t forget to keep sending in your brilliant, informative and humorous articles to: If you have any casualty or medical theme d quizzes, crosswords, word searches etc Send them along to:

VOL 43, No.2 MAY 2019