ENHANCED FIRST AID REFRESHER (EFAR) ONSHORE/OFFSHORE

Transcription

1 ENHANCED FIRST AID REFRESHER (EFAR) ONSHORE/OFFSHORE Version October 2018

2 CONTENTS LIST OF ABBREVIATIONS...4 CHANGE LOG...5 SCOPE...6 GENERAL REQUIREMENT TO GWO ENHANCED FIRST AID REFRESHER...7 Target group... 7 Aims and objectives... 8 Conformity with other Training... 8 Legal requirements... 8 Duration and organisation of EFAR Module... 8 Validity period... 8 Delegate prerequisites for the EFAR... 9 EFA Refresher Training... 9 Physical demands... 9 GENERAL RESOURCES REQUIRED TO DELIVER EFAR MODULES Training Staff Facilities and Equipment Theory training facilities Practical training facilities Training Equipment UNDERSTAND GWO LEARNING OBJECTIVES Taxonomy ADMINISTRATION AND CERTIFICATION OF EFAR MODULES Administrative arrangements Delegate performance assessment Requirement to upload training record in WINDA Training Providers own Records and Certificates issue MODULE: ENHANCED FIRST AID REFRESHER (EFAR) Aims and objectives of the EFAR Module Duration of the EFAR Module EFAR Trainer/Delegate Ratio Equipment for the EFAR module EFAR Module Time Table Detailed description of the EFAR Module Lesson 1 - Introduction Lesson 2 - Risks/Hazards/Legislation Lesson 3 - Anatomy Lesson 4 - Management of an incident - National Emergency Response - Medical Teleconsultation Lesson 5 - Lifesaving and Enhanced First Aid using primary and secondary survey Lesson 6 - Pain management and further possible medication Lesson 7 - Themes Lesson 8 - Scenario-based training Lesson 9 - Evaluation Delegate performance assessment / 60

3 ANNEX 1 - CONTROL MEASURES FORM (TEMPLATE) ANNEX 2 - MEDICAL SELF-ASSESSMENT FORM (TEMPLATE) ANNEX 3 - EFA GUIDELINE: RECOMMENDATIONS / 60

4 LIST OF ABBREVIATIONS AED AHA ANSI AS/NZS EFAR BST BSTR CO2 CPR CSA EFA EFAR EN ERC GWO WTG Automatic External Defibrillator American Heart Association American National Standards Institute Australia and New Zealand Standard Basic and Enhanced First Aid Training Refresher Basic Safety Training Basic Safety Training Refresher Carbon Dioxide Cardiopulmonary Resuscitation Canadian Standards Association Enhanced First Aid Enhanced First Aid Refresher European Standards European Resuscitation Council Global Wind Organisation Wind Turbine Generator 4 / 60

5 CHANGE LOG Table 1 - Change Log Amendments & Dates Ver. Changes Approved by & Dates 5 / 60

6 SCOPE The Global Wind Organisation (GWO) is an association of Wind Turbine owners and manufacturers with the aim of supporting an injury-free work environment in the wind industry. An objective of GWO is to develop common industry training and best practice Standards for health and safety as a vital and necessary way forward to reduce risks for personnel in the wind industry working on site and to reduce environmental risks across Europe and the globe. This Standard has been developed in response to the demand for recognizable Enhanced First Aid (EFA) training in the industry and has been prepared in co-operation between the members of GWO based on risk assessments and factual incident and accident statistics pertaining to the installation, service and maintenance of wind turbine generators and wind power plants. This Standard describes the requirements for Enhanced First Aid Refresher training that are recommended by the members of GWO. The members of the Global Wind Organisation (GWO) recognize trained persons as competent within EFA in the wind industry. GWO accepts the trained person as possessing the required knowledge, skills and attitude to provide ongoing care to an ill or injured casualty over a short period of time while waiting for professional emergency rescue teams to arrive. Training is verified through the GWO database WINDA. Where national legislation sets higher requirements for the specific training, the Training Provider shall incorporate these requirements into the training program. Additional training may be required for company or country specific reasons. This standard has been developed by the GWO Training Committee. Disputes and potential non-conformities should be brought to the attention of the GWO Audit and Compliance Committee. The standard has been approved by the GWO Steering Committee. 6 / 60

7 GENERAL REQUIREMENT TO GWO ENHANCED FIRST AID REFRESHER The Enhanced First Aid offers two options to attend the training - see below figure 1. New technicians can enter via the main EFA training which consists of Basic First Aid (FA) and EFA elements and two certificates FA and EFA will be issued. If you already have a GWO Basic First Aid (or refresher) FA (or FAR) certificate, you have the option of taking the Refresher First Aid (FAR) combined with EFA training elements and you will also receive two certificates EFAR and EFA after successful completion of the training. Figure 1 - Flowchart of EFA training process Delegates can join the main EFA training without prior basic FA training The Enhanced training EFA or EFAR includes all elements of the FA(R) training module At the end of the training the Delegates receive both a FA(R) and EFA(R) certificate Target group Personnel who will be working in the wind industry or related fields and will have their duties in a wind turbine environment, usually in physical contact with a wind turbine or an offshore wind structure. Personnel that is selected by their employer to perform Enhanced First Aid onshore or offshore, where training according to the GWO Enhanced First Aid training may enable them to react to incidents and thus mitigate the results of casualties deriving from the identified risks. The Annex 3 - EFA Guideline: Recommendations has been developed to assist employers in determining who and how many should take the training. 7 / 60

8 Aims and objectives The EFAR Training shall enable Delegates to support and care for others working in the industry by possessing the knowledge, skills and attitude of Enhanced First Aid. Upon completion of the GWOEFA Delegates will be able to administer safe, effective and immediate lifesaving and enhanced first aid measures to save life and give assistance in remote areas using advanced emergency equipment and medical teleconsultation. Conformity with other Training The GWO EFAR standard sets out minimum requirements. The modules, learning objectives, lessons and elements may be delivered in the order that fits best for the specific training situation. Provided the minimum requirements of the EFAR are met the Training Provider may choose to incorporate delivery of other similar certified training. Legal requirements The Training Provider shall identify whether national legislation sets additional requirements for EFAR or prohibits delivery of certain elements. If so, the Training Provider shall incorporate these identified requirements in the training or cancel particular elements. Duration and organisation of EFAR Module Table 2 - Duration of Modules Modules Duration (hours) EFAR 16 hours Within the module timetables, approximate duration of each of the lessons are given. The training provider may choose to deliver elements of the training according to other timetables, as long as the total duration is not reduced, and practical elements are not reduced in length. Theoretical elements may be delivered during the practical exercises when feasible. Validity period The EFAR is valid for the period of 24 months as stated in the table below. Certificates and training records shall be renewed before the end of a given validity period. A certificate or training record can be renewed up to two months prior to expiry and maintain the original certification date by uploading the previous certificate s valid until date in WINDA. If a certificate or training record is renewed outside of two months of expiry, it must carry the new date of certification. 8 / 60

9 A Delegate is only allowed to attend a refresher course in the specific EFAR Training prior to the date of expiry on the current certificate or training records. If a certificate or training record is expired, the Delegate must attend the full Enhanced First Aid training to obtain new training records in Basic and Enhanced First Aid. The validity period is automatically calculated in WINDA by entering the course completion date. Table 3 - Certificate Validity of Course/Modules Course/Modules Certificate Validity (Months) EFAR 24 Months Delegate prerequisites for the EFAR All personnel participating in Enhanced First Aid refresher shall be medically fit and capable of fully participating. Training providers shall have a procedure that requires Delegates to sign a statement stating that they are medically fit to participate in the training and that they do not suffer from any medical illness or are under influence of any narcotic substance or alcohol. The Annex 2: Medical Self-Assessment Form shall be used if no other equivalent procedure is in place. Delegates signatures testifying to their medical fitness shall be collected prior to the start of the Enhanced First Aid refresher course. Furthermore, Delegates shall have created a personal Delegate profile in WINDA and provide their own WINDA ID prior to completing the EFAR training. EFA Refresher Training The GWO EFA training (Refresher) is to be refreshed continuously and regularly within 24 months in a total duration of 2 days (EFAR) supported by relevant drills and exercises ref. Annex 3: EFA Guideline: Recommendations. Physical demands EFAR Modules may potentially be physically demanding. If there is any doubt regarding the medical fitness of any Delegate, the Training Provider shall stop training the Delegate and seek a physician s advice. Note: Practical exercises shall be designed and delivered solely to meet this Standard and shall not place any physical or mental demands on the Delegates other than those required to meet this Standard. 9 / 60

10 GENERAL RESOURCES REQUIRED TO DELIVER EFAR MODULES The Training Provider shall ensure that Staff, facilities and equipment are in place to support the training of Delegates. Training Staff The Instructor shall possess appropriate qualifications and experience to ensure that all training and supportive activities are carried out in accordance with current legislation and current CRITERIA FOR TRAINING PROVIDERS OFFERING GWO TRAINING. Instructors must be: Trained in instructional/lecture techniques and/or have documented instructional/ teaching experience Continually trained medically and educationally in adequate time intervals Included in an on-going training program, which includes visits to onshore and/or offshore wind turbine generators (WTG) (tower, nacelle, hub) prior to instructing Enhanced First Aid training, to enable them to maintain and update skills related to the courses they instruct. Instructors shall physically visit the tower, nacelle and hub of WTGs Able to demonstrate competencies in pre-hospital emergency care with evidence of practice e.g. a valid certificate for practicing a pre-hospital functions as medical technician or similar Knowledgeable within medical teleconsultation. All Staff shall possess the appropriate competencies to conduct/assist the elements of training they have been assigned to. Facilities and Equipment The full range of facilities and equipment relevant to the modules delivered shall be available during the training. The following facilities criteria shall be adhered to. Theory training facilities Facilities shall be designed to enable each Delegate to see, hear and fully participate in the taught subject matter. Practical training facilities All facilities shall be maintained and where appropriate, inspected and tested in accordance with current national legislation and manufacturers recommendations. Risk assessments shall be conducted and documented for all training facilities. The Training Provider shall hold the required permits to operate the facilities. 10 / 60

11 The learning process during "scenario-based training" is facilitated by identical or comparable elements comparing the training environment and the delegates working environment. Identical or comparable elements enhances the application of what is learned. The practical training facilities and a training environment are expected to incorporate as many identical or comparable elements to a real wind turbine working environment as possible. The objective is that the practical training facility should enable each Delegate to individually and/or as part of a team, see, hear and practice the taught subject matter in such a way, that it resembles the working practices in a real wind turbine environment. The facilities shall enable training to be executed by doing relevant work tasks end-toend under realistic simulated working procedures, and/or realistic simulated emergency situations (fire, first aid, evacuation or casualty rescue) end-to-end scenarios in a real or simulated wind turbine environment. Training Equipment The required equipment for training shall be available and shall fulfil national legal requirements. The equipment shall be maintained, inspected and tested in accordance with current national legislation and manufacturers recommendations. Risk assessments shall be conducted and documented for all training equipment. The Training Provider shall hold the required permits to operate relevant equipment. 11 / 60

12 UNDERSTAND GWO LEARNING OBJECTIVES The described learning objectives (expected learning outcome) are the foundation of the course contents and what the delegate performance assessment must be based upon. Traditionally learning objectives are prepared within three different domains of learning knowledge, skills and attitude. A learning objective describes the expected learning outcome on completion of a module or a course, within one or more learning domains. If a learning objective is related to more than one domain of learning, e.g. to knowledge and skills, one learning objective per learning domain is often prepared to enable a better understanding of the learning objective. The GWO Training Provider may apply teaching methods (didactics) that are appropriate to the course participants prior training, education and cultural backgrounds, but should always aim to provide course participants ample possibility to perform hands-on demonstrations and learning reflection. Taxonomy To formulate a measurable learning objective, taxonomy is used to describe the level of expected learning outcome within a learning domain. As an example belonging to the learning domain of knowledge, to have a delegate name or recognize something, as oppose to have him explain it in his own words, or even apply or demonstrate what he has learned describes different performance levels, i.e. different taxonomy levels. Different taxonomies are associated with different learning domains, for instance: Knowledge: such as Bloom s cognitive taxonomy Intellectual knowledge, mental skills and procedures Skills: such as Simpson s psychomotor taxonomy Physical skills, cognitive controlled and observable Attitude: such as Krathwohl s affective taxonomy Attitude and feelings to the learning Selecting a suitable taxonomy level, an action verb expresses the expected behavior of the delegate, thus describing the taxonomy level of a learning objective. Action verbs are usually highlighted in bold in this standard. The table below presents the three learning domains with taxonomy level 1-3, provided with associated action verbs applicable in the learning objective wording, defining the taxonomy level. In the Enhanced First Aid refresher standard, the learning objectives are in general described as level 2 or / 60

13 Table 4 - Learning domains with taxonomy level 1-3. Knowledge Skills Attitude 3 Application / Applying To use in a new situation. Solving problems by applying acquired knowledge, facts, techniques and rules in a different way. Applying a procedure to a familiar or unfamiliar task. Using a manual to calculate and operate. Action verbs Apply, Change, Choose, Compute, Modify, Operate, Practice, Prepare, Schedule, Solve, Write. Guided response Follows instructions to build a model. Using a tool after observing an expert demonstrate how to use it. Be able to demonstrate an activity to other learners. Can complete the steps involved in the procedure as directed. Action verbs Accomplish, Achieve, Calibrate, Complete, Control, Demonstrate, Perform, Refine, Show. Value Demonstrates belief in the company described process. Shows the ability to solve problems. Informs management on matters that one feels strongly about. Decide worth and relevance of ideas and tasks. Action verbs Argue, Challenge, Confront, Complete, Debate, Criticize, Justify, Join, Propose. 2 Comprehension / Understanding Construct a meaning from instructional messages, including oral, written and graphic communication. Demonstrating basic understanding of facts and ideas. Explain in your own words the steps of performing a complex task. Action verbs Classify, Distinguish, Estimate, Explain, Express, Give, Illustrate, Indicate, Locate, Predict, Summarize, Translate. Set Awareness or knowledge of the ability needed to use the skill. Carry out tasks from verbal or written instructions. Showing eagerness to assemble components to complete a task. Knows and acts upon a sequence of steps in a process. Action verbs Access, Build, Complete, Conduct, Execute, Implement, Operate, Perform, Recreate. Respond Completing work assignments with highly respect to the agreement. Participating in team problem solving activities. Questions new ideas and concepts in order to fully understand them. Participate actively and respectful in discussions. Showing enthusiasm. Action verbs Assist, Contribute, Discuss, Present, Question, Report, Respond, Tell, Write. 1 Knowledge / Remembering Memory of facts, terminology, rules, sequences, procedures, etc. Locating knowledge in longterm memory and retrieving Perception Watch instructor and repeat action, process or activity. Receive Listening to discussions of controversial issues with an open mind. Respecting the rights of others. 13 / 60

14 relevant knowledge from long-term memory. Action verbs Arrange, Define, Describe, Find, Identify, List, Name, Outline, Recognize, Relate, Recall, Retrieve. Recognizing sounds or pictures that indicate certain functionalities. Estimate the event of a certain function and be prepared for it. Action verbs Attempt, Copy, Duplicate, Follow, Organize, Repeat, Sketch, Replicate, Reproduce. Listen to others and remember their opinions. Be positive and creative to what is being taught. Action verbs Ask, Be open to, Concentrate, Discuss, Focus, Follow, Listen, Reply, Take part. Note: Higher taxonomy levels exist. 14 / 60

15 ADMINISTRATION AND CERTIFICATION OF EFAR MODULES Administrative arrangements Appropriate for the enrolment and certification of Delegates and all aspects of the delivery of training shall be in accordance with this Standard. Delegate performance assessment Delegates will be assessed by means of direct observation and supplementary oral questions where appropriate (formative evaluation). Throughout the entire course the instructor will enforce the Delegate Assessment Form (see annex 1) and adhere to it, accordingly, with a high focus on evaluating the Delegate s practical skills. The Trainer keeps a Delegate Assessment Form (or adaptation) for each Delegate until the completion / evaluation of the EFAR Module. The Delegate Assessment Form (or adaption) is a final evaluation tool for the instructors to assess Delegates during practical elements. It allows measurement of the number of violations in regard to safety, competency, or attitude. It shall be used as a progressive evaluation tool to discuss the performance of a Delegate in guiding them to success and it also serves as supporting documentation if a Delegate passes or fails the Module. If a Delegate fails to meet the demands of the EFAR module, they shall attend a new EFAR Module. Training Provider may adapt the Delegate Assessment Form to other media. Training Providers shall have a documented procedure in place for dealing with Delegates not meeting the stated learning outcomes. Requirement to upload training record in WINDA Training Providers are responsible for uploading a record of training to WINDA, the GWO online database of training records. This must be done as soon as possible and no later than 10 working days after completion of the training program. Each record shall contain the following: 1) Delegate s WINDA ID 2) Course code 3) Course completion date Course codes: Enhanced First Aid Refresher EFAR 15 / 60

16 Training Providers own Records and Certificates issue The Training Provider shall in accordance with the criteria for Training Provider maintain own records of Delegates. Upon request from GWO or any of the members of GWO, the Training Provider shall be able to verify the training and competence records of any specific personnel either attending a course and/or performing training of a course by name and nationality. Training providers may issue other additional proof of training, e.g. as paper certificate or plastic cards. If the training provider chooses to do so, it is recommended (not a requirement) to include the delegate WINDA id. 16 / 60

17 MODULE: ENHANCED FIRST AID REFRESHER (EFAR) 1.1 Aims and objectives of the EFAR Module The aim of this EFAR Module is to review and build on previously gained knowledge and skills from BST First Aid or to refresh current EFA skills through theoretical and practical training so that Delegates can administer safe and effective Enhanced First Aid in the wind industry. The EFAR Module shall ensure that the following objectives are covered: Local legislation/risks/hazards and demands to ensure knowledge of the roles, responsibilities and rules that apply to Enhanced First Aid in Remote Areas The importance of carrying out basic and enhanced First Aid in a safe and sound manner, in accordance with the legislative requirements of their geographic location and according to European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines Identifying and explaining normal function, normal signs and symptoms of serious and minor injuries and illness related to the human body Demonstrating understanding and correct order of management in an emergency situation in a Wind Turbine Generator (WTG) environment Delivering immediate enhanced first aid to stabilise the casualty, to include but not limited to: Stopping life-threatening bleeding Establishing and maintaining an airway Knowing the indications for and the use of Automated External Defibrillator (AED) Using basic and advanced First Aid equipment in a First Aid scenario Resuscitation Using standardised methodologies, specifically the Primary and Secondary Survey - based on the "C"-A-B-C-D-E principle Assessing the casualty, for injury or acute illness, to determine if medical advice and external-to-incident support is required; to include but not limited to: Life-threatening bleeding, circulatory disorder Impaired consciousness Compromised airway, breathing, too slow or too fast Immediate life-threatening illnesses and other health problems especially with severe pain Requesting telemedical consultation and medical/rescue assistance providing a concise and relevant report of the casualty s condition and obtaining medical advice to further stabilise the casualty by using: Telemedical consultation through National resources (e.g. Coastguard) Telemedical consultation through private contractor (where established) 17 / 60

18 Requesting immediate medical/rescue assistance providing a concise and relevant report of the casualty s condition Preparing the casualty for transfer to nominated evacuation/rescue point, including: Immobilisation where required or other non-medical mitigation e.g. cooling gels Understanding the complexity and restrictions of medical pain relief and the role of clinical governance in the control of medication Accompanying the casualty, if required, to suitable medical facility and formally hand over the casualty Escorting the casualty to the nominated evacuation/rescue point providing continued enhanced first aid Acting as a leader in first aid situations Administering safe, effective and immediate lifesaving and enhanced first aid measures to save life and give assistance in remote areas using advanced emergency equipment and medical teleconsultation, while having particular regard for personal-protection 1.2 Duration of the EFAR Module The optimal total time for completing this EFAR Module is estimated to be 16 hours, including meals and breaks. This EFAR training shall focus on the access and egress conditions encountered in wind turbine environments. The practical skills shall be trained and demonstrated in a restricted area of movement and all elements of the course shall be covered by demonstration and practical exercises, where possible. If this training is part of a programme of longer duration, the total contact time per day shall not exceed 8 hours and the total training day shall not exceed 10 hours. The total training day includes contact time, refreshment and meal breaks and travel between training sites, where applicable. It shall be ensured that everyone is given the opportunity to share their opinions and experiences, where possible. Ensure that Delegates with prior experience share their experiences related to (Enhanced) First Aid in a way that is constructive for the entire class. 1.3 EFAR Trainer/Delegate Ratio The ratio shown for theory sessions indicates the maximum number of Delegates that can attend the course. The ratio shown for practical sessions indicates the maximum number of Delegates to be supervised by one instructor during each activity. 18 / 60

19 Module Session Trainer Delegate Ratio EFAR Module Theory 1:12 Practical 1:6 1.4 Equipment for the EFAR module The following equipment is required during the entire duration of this EFAR Training to meet the needs of the EFAR First Aid Training Module: 1) Torso anatomy dummy 2) Airway model 3) Resuscitation dummies - adult and child (e.g. for ventilation, laryngeal tubes, AED use, immobilization) 4) First Aid equipment 5) First Aid bag 6) Make - up kit for First Aid scenarios 7) AED (Automated External Defibrillator) according to national best practise 8) Bag valve mask incl. accessories, national best practise airway devices e.g. laryngeal tubes (sizes. 4/5), supraglottic airway device, oropharyngeal tube, manual suction device 9) Pulse oximeter for heart rate monitoring 10) Trauma pressure dressing, haemostatic agents/dressings, tourniquet 11) Eyewash fluid 12) Medications e.g. analgesic, cooling gel (exercise samples without active ingredients) 13) Splint material, basic immobilisation, pelvic sling, chest seals 14) Cervical immobilizer according to national best practice 15) Blankets and/or chemical active warming blanket 16) Equipment for medical teleconsultation 17) Suitable media (e.g. videos) 18) Stretcher/spineboard In order to comply with national legislation and Standards, the equipment supplied and used by staff and Delegates shall follow the appropriate guidelines, e. g.: 19 / 60

20 Europe - EN USA - ANSI Australia and New Zealand - AS/NZS UK - BS Canada - CSA Asia - ANSI / EN Note: All equipment shall be maintained and where appropriate, inspected and tested in accordance with current national standards/legislation and manufacturers recommendations. 1.5 EFAR Module Time Table The order in which the elements of this EFAR training Module are delivered may vary. Within the module timetables, approximate duration of each of the lessons are given. The training provider may choose to deliver elements of the training according to other timetables, as long as the total duration is not reduced, and practical elements are not reduced in length. Theoretical elements may be delivered during the practical exercises when feasible. Lesson Element Approximate Duration (min.) 1 Introduction 1.1 Safety instructions and emergency procedures 1.2 Facilities 1.3 Introduction 1.4 Scope and main objectives 1.5 On-going assessments (Delegate Assessment Form) 1.6 Motivation TOTAL 15 min. 2 Risks/Hazards/Legislation 2.1 Risks and hazards 2.2 First Aid guidelines and emergency plans 2.3 National legislation 2.4 Global legislation TOTAL 15 min. 20 / 60

21 3 Anatomy 3.1 The human body s life conditions, structure, function and signs 3.2 Understanding of personal hygiene TOTAL 40 min. 4 Management of an incident - National Emergency Response - Medical Teleconsultation 4.1 Safety awareness in an emergency situation 4.2 Management of an incident 4.3 Emergency Rescue Teams, Emergency Calls and Medical Teleconsultation TOTAL 50 min. 5 Lifesaving and Enhanced First Aid using Primary and Secondary Survey 5.1 "C" A B C D E Principle 5.2 Primary Survey 5.3 C : Critical bleeding 5.4 A: Airway 5.5 B: Breathing 5.6 C: Circulation 5.7 Secondary Survey 5.8 D: Disability 5.9 E: Environment/Exposure 5.10 Psychological First Aid TOTAL 280 min. 6 Pain management and further possible medication 6.1 Application algorithm 6.2 Further Possible Medication TOTAL 40 min. 21 / 60

22 7 Themes Choose one of the following 5 themes for instruction 7.1 Theme 1: Psychological effects of First Aid 7.2 Theme 2: Sudden sickness and environmental factors 7.3 Theme 3: Types of trauma 7.4 Theme 4: Incident management and situational awareness 7.5 Theme 5: Complex incidents with several (2-5) casualties TOTAL 100 min. 8 Scenario-based training 8.1 Practice First Aid techniques TOTAL 245 min. 9 Evaluation 9.1 Summary 9.2 Evaluation 9.3 Training records TOTAL 15 min. GRAND TOTAL 800 min. 1.6 Detailed description of the EFAR Module The learning outcomes specified for the EFAR Module are: Note: The administrative part of the registration should be carried out before the course commences. 22 / 60

23 LESSON 1 - INTRODUCTION 15 min. The aim of this lesson is to give the Delegates the needed awareness of the Refresher Course content and the facilities involved in order to ensure that all Delegates are aware of what to expect and what is expected of them during the course. To successfully complete this lesson of the EFAR Module, Delegates shall be aware of: Safety instructions and emergency procedures Facilities Introduction Scope and main learning objectives On-going assessment (Delegate Assessment Form) Motivation ELEMENT SAFETY INSTRUCTIONS AND EMERGENCY PROCEDURES The Instructor shall explain: Safety instructions according to internal procedures Emergency procedures and emergency exits for the areas the Delegates will be located during the course ELEMENT FACILITIES The Instructor shall explain: General description of the facilities at the training location (Administration, dining area, restrooms, toilets, etc.) ELEMENT INTRODUCTION The Instructor shall give: A short introduction, including their backgrounds as instructors Delegates shall give: A short introduction, including job function and expected primary geographic work location The Instructor shall explain: The programme of the EFAR Module, including breaks and meal times 23 / 60

24 ELEMENT SCOPE AND MAIN OBJECTIVES The Instructor shall explain: Scope and main objectives of this EFAR Module ELEMENT ON-GOING ASSESMENTS (DELEGATE ASSESSMENT FORM) The Instructor shall explain: The reasons for the on-going assessment GWO Delegate Assessment and their use ELEMENT MOTIVATION The Instructor shall explain: The importance of personal involvement in the course The definition and need for correct Enhanced First Aid Chain of survival The importance of refreshing and building on previously acquired understanding, knowledge and skills in First Aid LESSON 2 - RISKS/HAZARDS/LEGISLATION 15 min The aim of this lesson is to refresh and increase Delegates previously acquired knowledge of the relevant risks/hazards/legislation and demands of First Aid in order to improve their awareness of the roles, responsibilities and rules that apply to First Aid. To successfully complete this lesson of the EFAR Module, Delegates shall be able to: Explain risks and hazards relating to (Enhanced) First Aid in a WTG environment as well as relating to remote areas with dangerous locations/tasks Explain various First Aid guidelines (e.g. ERC and AHA) in the context of (Enhanced) First Aid in a WTG environment Summarize national legislation relevant to (Enhanced) First Aid Recognize global legislation relevant to (Enhanced) First Aid 24 / 60

25 ELEMENT RISK AND HAZARDS The Instructor shall lead the discussion on: Risks and hazards involved in an incident relevant for job functions within the wind industry: Difficulties in Management of accidents /emergencies / survival in remote areas Dependency on site organisation, types of activity, work location and personnel Onshore Offshore Remote areas in general ELEMENT FIRST AID GUIDELINES The Instructor shall explain: Recent changes/updates to guidelines from ERC and AHA* *If ERC and/or AHA guidelines have changed, these changes shall be discussed during this EFAR Module ELEMENT NATIONAL LEGISLATION The Instructor shall explain: Recent changes/updates to national legislation Recent changes/updates to national legal requirements Recent changes/updates to national legal responsibilities Recent changes/updates to the role of First Aid in the wind industry ELEMENT GLOBAL LEGISLATION The Instructor shall explain: Refreshing site organisation and types of units on a site and using of the Delegates personal practical experiences Recent changes/updates to global legislation Recent changes/updates to global legal responsibilities 25 / 60

26 LESSON 3 - ANATOMY 30 min The aim of this lesson is to refresh and increase Delegates previously acquired knowledge and skills regarding the human body. Delegates will be able to identify and explain normal bodily function, signs, symptoms and functions of major and minor injuries and illness related to the human body. To successfully complete this EFAR Module, Delegates shall be able to demonstrate: Understanding of the human body s life conditions, structures, functions and signs Knowledge and skills for detecting abnormal signs, symptoms and functions of serious and minor injuries Knowledge and skills for detecting abnormal signs, symptoms and functions of serious and minor illness related to the human body Understanding of anatomy and First Aid in emergency situations Understanding of personal hygiene ELEMENT THE HUMAN BODY S LIFE CONDITIONS, STRUCTURES, FUNCTIONS AND SIGNS Delegates shall explain and demonstrate: Normal life conditions for the human body Human cells and life conditions Cells and Oxygen (O2) Role of carbon dioxide (CO2) on cells Vital organs and their requirements Vital systems of the human body Nervous system Respiratory system Circulatory system Other systems and organs Nervous system Anatomy of the nervous system Structure, functions and normal signs Threats to the nervous system 26 / 60

27 Respiratory system Anatomy of the respiratory system Structure, functions and normal signs Threats to the respiratory system Circulatory system Anatomy of the circulatory system Structure, functions and normal signs Threats to the circulatory system Other systems and vital organs of the human body Anatomy of vital organs Structure and functions Threats to vital organs The Instructor shall explain and demonstrate: If Delegates do not cover all points during their review, the Instructor shall ensure that following topics are covered: Life conditions, structure, function and signs of the human body Serious and minor injuries - signs, symptoms and function Serious and minor illness - signs symptoms and function Use of anatomy and First Aid in emergency situations ELEMENT UNDERSTANDING OF PERSONAL HYGIENE The Instructor shall explain: Personal hygiene As a First Aider Protection and use of barriers in emergency situations 27 / 60

28 LESSON 4 - MANAGEMENT OF AN INCIDENT - NATIONAL EMERGENCY RESPONSE - MEDICAL TELECONSULTATION 50 min The aim of this lesson is to give the Delegates the knowledge, skills and attitude to demonstrate understanding and correct order of management of emergencies (accident/illness) in remote areas. To successfully complete this lesson, Delegates shall be able to: Understand personal hazards to rescue personnel and victim associated with emergency situations and apply knowledge and skills for safety awareness Perform skills to take FA-measures with regard for personal protection Show knowledge about core aspects of psychological care in first aid situations Demonstrate understanding and skills to approach and manage different emergency situations Demonstrate understanding of the principles of the ACT Method (Assess, Communicate, Triage) and recognize the importance of raising the alarm before starting first aid Demonstrate skills on how to ensure the rescue of injured persons and their removal from the immediate hazard area to the nearest safe location Conduct proper emergency calls in a remote situation Distinguish and use of the adequate measures given by the chain of survival Transfer understanding of functions and support from Emergency Rescue Teams in WTG environments Use clear communication in a team setting Administer Enhanced First Aid via medical teleconsultation ELEMENT SAFETY AND AWARENESS IN AN EMERGENCY SITUATION The instructor shall lead a discussion on: "Safety first" Appropriate safety behavior and awareness as an Enhanced First Aider in a WTG The risks and hazards of working in the wind industry with special focus on remote locations and the chain of survival How to spot and stop hazardous rescue situations 28 / 60

29 Safety for all persons involved in an accident The core aspects of psychological care in first aid situations ELEMENT MANAGEMENT OF AN INCIDENT The instructor shall explain and demonstrate: Managing an incident How to follow an efficient and correct First Aid structure Analysis and management of an incident Different emergency situations in the wind industry Call for help - challenges onshore Call for help - challenges offshore Moving or not moving a casualty in different emergency situations (risks of e. g. fire, water versus deteriorating injuries) How to move and place a casualty (depending on injuries, ref: lesson 5) How to move and place a casualty in the recovery position Delegates shall explain and demonstrate: Managing an incident How to follow an efficient and correct First Aid structure Analysis and management of an incident Different emergency situations in the wind industry Call for help - challenges onshore Call for help - challenges offshore Moving a casualty with two First Aiders Moving a casualty alone ELEMENT EMERGENCY RESCUE TEAMS, EMERGENCY CALLS AND MEDICAL TELECONSULTATION The instructor shall explain: Emergency Rescue Teams Functions of Emergency Rescue Teams 29 / 60

30 Co-operation with Emergency Rescue Teams Challenges for Emergency Rescue Team on site Skills for supporting professional emergency services The means of bridging the time while waiting for professional help to arrive The use of the principles of ACT Method (Assess, Communicate, Triage) The principles of emergency calls in accordance with emergency response plans The means and use of medical teleconsultation focusing on the current and future applicability and technical infrastructure The administering of First Aid measures via medical teleconsultation Delegates shall practise and demonstrate: A proper emergency call in a remote situation The use of medical teleconsultation and communication media Performance of First Aid measures in representative work setting comparable to specific remote locations including the use of medical teleconsultation LESSON 5 - LIFESAVING AND ENHANCED FIRST AID USING PRIMARY AND SECONDARY SURVEY 280 min. The aim of this lesson is to give the Delegates knowledge, skills and steps to follow a methodical sequence to identify and treat life threatening time critical injuries and illnesses. Delegates shall be able to demonstrate correct use of Lifesaving and Enhanced First Aid using the "C"-A-B-C-D-E principle during primary and secondary survey supported by teleconsultation. Further aim of this lesson is to give the Delegates confidence and skills to be able to deliver immediate enhanced first aid to stabilize the casualty and to perform basic life support with the help of additional FA equipment, such as supplemental respiratory aids and the use of an Automatic External Defibrillator (AED). Delegates shall receive the knowledge and skills to be able to assess, assist and provide the necessary First Aid to special incidents frequently occurring after injuries/accidents or during illnesses. To successfully complete this lesson, Delegates shall be able to: Understand the principles of Primary and Secondary survey 30 / 60

31 Assess a casualty using the Primary and Secondary Survey Immediate First Aid actions using Primary and Secondary Survey and the "C"-A-B-C- D-E- principle Treatment of Catastrophic external haemorrhage "C" critical bleeding Deliver correct First Aid for obstruction of airways - establish and maintain an airway Implement the required recovery position, dependent on the status Correct First Aid to an unresponsive and breathing/not breathing casualty Perform Cardiopulmonary Resuscitation (CPR) Understand the capabilities, the different technical specifications and safe use of AEDs Understand the enhanced use of AED through help of medical teleconsultation Provide knowledge of the benefits of airway management devices during resuscitation (resuscitation bag incl. accessories, pocket mask, laryngeal tube) Apply techniques to assess circulation (e.g. pulse oximeter for heart rate monitoring) Deliver correct First Aid for external and internal bleeding Deliver correct First Aid for shock Identify signs and symptoms of serious and minor injuries and illnesses Deliver Enhanced First Aid for acute illnesses of deteriorated disorders/diseases which are critical in terms of time Understand psychological First Aid ELEMENT THE "C"- A-B-C-D-E- PRINCIPLE The Instructor shall explain and demonstrate: Meaning of the "C"- A-B-C-D-E- principle Procedure of Primary and Secondary Survey ELEMENT PRIMARY SURVEY The Instructor shall explain and demonstrate: Conditions and procedure of Primary survey comprising assessment of risks and threats for First Aider and victim, safety awareness, rescue measures, emergency call First approach using the C -A-B-C-D-E-principle as steps to follow a methodical sequence to identify and treat life threatening time critical injuries and illnesses Check for response ("look, listen, feel") to find out: alert - voice/pain responsive - unresponsive 31 / 60

32 The Delegates shall practice and demonstrate: Delivering Enhanced Life Saving First Aid using the "C"-A-B-C-D-E principle during primary survey supported by teleconsultation. ELEMENT "C" CRITICAL BLEADING The Instructor shall explain and demonstrate Haemostasis of Critical/Catastrophic external hemorrhage: Threat and detection of catastrophic bleeding Haemostasis using algorithm-oriented procedures Correct treatment of a casualty with catastrophic external hemorrhage including the use of normal and enhanced first aid equipment: o o o o Direct pressure Pressure dressings Haemostatic agents/dressings Tourniquets ELEMENT A: AIRWAY The Instructor shall explain and demonstrate: Obstruction of airways, respiratory disorders Reasons for obstruction of airways, breathing - not breathing Threats First Aid to an unresponsive, breathing casualty Adults and children Placing of a casualty in the recovery position (lying) and use of the rescue blanket The Delegates shall practise and demonstrate: Checking airways Response and slowdown of casualties Removal of occluding objects Recovery position - single First Aider Recovery position - two First Aiders 32 / 60

33 ELEMENT B: BREATHING - CARDIOPULMONARY RESUSCITATION (CPR) The Instructor shall explain and demonstrate facilitation of breathing: Casualty position needed to facilitate breathing Casualties not breathing, unresponsive Cardiopulmonary Resuscitation (CPR) through the use of training dummies: Reasons for being unresponsive and not breathing Threats Performing CPR on adults - single First Aider correct use of AED and ventilatory equipment Performing CPR on adults - two First Aiders correct use of AED and ventilatory equipment The capabilities and the different technical specifications of AEDs AED safety procedures including environment conditions (wet, metallic) Correct treatment of a casualty who requires ventilatory support including: o o o Use of a pocket face mask Use of a bag valve mask Use of suction Correct treatment of a casualty with an obstructed airway using the following national best practice airway management devices (according to country/company regulations): o Oropharyngeal tube (Guedel) and/or o Supraglottic airway and/or o Laryngeal tubes (sizes 4/5) o Bag valve mask resuscitation o Mouth-mask resuscitation (pocket face mask) o Placing the laryngeal tube and/or supraglottic airway Delegates shall practice and demonstrate: Performing CPR on adults - single First Aider correct use of AED and ventilatory equipment Performing CPR on adults - two First Aiders correct use of AED and ventilatory equipment Treatment of a casualty who requires ventilatory support using advanced First Aid equipment/airway management devices: o o Bag valve mask resuscitation Mouth-mask resuscitation (pocket face mask) 33 / 60

34 o Laryngeal tube and/or supraglottic airway Reanimation with correct use of resuscitation equipment and help of medical teleconsultation, enhanced using an AED as well as inserting supraglottic airway and/or the laryngeal tube (2 care-giver method) Note: Resuscitation According to the European Resuscitation Council Guidelines for Resuscitation ELEMENT C: CIRCULATION Instructor shall explain and demonstrate: Circulation - Assessment techniques Skin colour Capillary refilling time Pulse Correct functioning and informative value of a pulse oximeter for heart rate monitoring Bleeding, external Reasons for external bleeding Threats Use of advanced First Aid equipment The Delegates shall practice and demonstrate: First Aid when a casualty is bleeding externally Bandaging Use of advanced First Aid equipment The Instructor shall explain and demonstrate: Bleeding, internal Reasons for internal bleeding Threats Use of medical teleconsultation 34 / 60

35 The Delegates shall practice and demonstrate: First Aid when a casualty is bleeding internally Recurring surveys Identify and treat shock (see 5.5.6) The Instructor shall explain and demonstrate: Shock Reasons for shock Types of shock Threats Recurring surveys Use of advanced First Aid equipment First Aid to shock The Delegates shall practice and demonstrate: Use of advanced First Aid equipment First aid treatment of shock The Instructor shall explain and give examples on: Acute illnesses of deteriorated disorders/diseases Heart attacks, strokes, seizure disorders, suspension syncope and other casualties out of general or internal medicine, which are critical in terms of time The reasons, frequency and risks of these diseases Minor incident in an escalating to a serious incident FAST-schema (Face, Arms, Speech, Time) as assessment for stroke Necessity of support by medical teleconsultation 35 / 60

36 Discuss the difficulties of EFA The Instructor shall show the procedure and value of: Taking care of the casualty / psychological FA-techniques Contacting professional rescue personnel nearby Using medical teleconsultation services for advice on pain management and medication (ref. lesson 6) The Delegates shall explain and practise: Assessment of stroke following FAST schema (see ) Continuous monitoring of casualty in cases of deteriorated disorders Early use of medical teleconsultation services ELEMENT SECONDARY SURVEY The Instructor shall explain: The general conditions of secondary survey using the A-B-C-D-E - principle without "C" The A - B C - D E- principle in the context of the secondary survey The differences between/indications for sitting, lying and shock position (conscious/unconscious) and the importance of keeping up body temperature ELEMENT D: DISABILITY Consciousness The Instructor shall explain and demonstrate 3 stages of consciousness: Conscious with adequate reactions to questions and situations, alert Inappropriate behavior and reactions, but awake (e. g. after stroke, drugs etc.) Unconscious without any reactions, unresponsive 36 / 60

37 The Delegates shall be able to: Distinguish the 3 stadiums of Consciousness Perform adequate FA measures Damages and poisoning through contact with chemical / biological agents The Instructor shall explain and demonstrate toxic / allergic symptoms of the body: Assessment of different reactions of the body Immediate first aid measures The need of medical teleconsultation for further treatment The Instructor shall explain and demonstrate superficial chemical burn of skin / eye injury: Align with emergency / company physician because of removal/antidote Application of bandages and the use of an eyewash bottle The Delegates shall perform: Washing/removal procedure and sterile dressing Application of bandages and the use of an eyewash bottle Bone fractures and injuries to joints/muscles The instructor shall explain and demonstrate: Body check: Examination of the casualty from head to toe (skull, thorax, upper extremities, abdomen, spinal column, hips, lower extremities) How to take measures to immobilize and perform proper axial, pain-relieving positioning Rest - Ice - Compression - Elevation (R - I -C - E) method Serious chest injuries and their management, including the use of chest seals 37 / 60

38 The Delegates shall recognize and assist: The use of splints, spineboard and other immobilization/stabilization materials (e.g. pelvic sling) Positioning with head injuries ELEMENT E: ENVIRONMENT/EXPOSURE Hypothermia/Hyperthermia and Heat Stroke The Instructor shall explain: The stages of hypothermia and hyperthermia and the appropriate measures The difference between heat exhaustion/heat stroke The use of active warming blankets Cooling measures for heat exhaustion/heat stroke The Delegates shall explain and recognize: The dangers of hypothermia and how to take appropriate measures The difference between heat exhaustion and heat stroke The use of active warming blankets Drowning and water immersion The Instructor shall explain: Stages and threats of water immersion: Cold shock Physical incapacitation Hypothermia Collapse: just before, during, or just after rescue First aid depending on the symptoms of the casualty: Continuous monitoring of the causality with the support of teleconsultation because of possible deteriorating stages 38 / 60

39 The Delegates shall explain and describe: Correct actions for those recovered from water immersion Threats and necessity of medical teleconsultation support Burn The Instructor shall explain and demonstrate: Cooling measures Application of a burn dressing The Delegates shall perform: Application of a burn dressing Bite Wounds The Instructor shall explain and demonstrate: Severe, possible secondary infected bite wounds, e. g. by dogs Bites for example of bats or raccoons possibly transmitting viral diseases like rabies Snake bites with toxins The Delegates shall be able to: Distinguish different forms / threats of bites Know importance of companies OHS strategy depending on assessment on site Use advice of medical teleconsultation services ELEMENT PSYCHOLOGICAL FIRST AID The Instructor shall explain aspects of Psychological First Aid: Reactions to an unusual situation/ extreme event, and how to mitigate abnormal reactions 39 / 60

40 Behaviour to a casualty To the surroundings and next of kin LESSON 6 - PAIN MANAGEMENT AND FURTHER POSSIBLE MEDICATION 40 min. The overall aim of this lesson is to give the Delegates an understanding of the complexity and restrictions of medical pain relief and the role of clinical governance in the control of medication. Depending on enhanced FA-Equipment (especially drugs for medication on site after release through the emergency-call-physician) EFA can apply knowledge of legal medication in casualties and administering appropriate medication to the victims. Note: Practical content of equipment for EFA should be supplemented at the request of the company physician, especially application of other medication according to national regulations. To successfully complete this lesson of the EFA Module, Delegates shall be able to: Master the application algorithm for pain management Administer safe and correct further possible medication via medical teleconsultation ELEMENT APPLICATION ALGORITHM OF PAIN MANAGEMENT The instructor shall explain and demonstrate: Numerical rating scale for pain Non-medicinal treatment according to the step-scheme of pain relief Clarification of prerequisites for the application of medicinal pain relief through the emergency-call physician Delegates shall be able to demonstrate: Correct management of a casualty in pain including: Assessment of pain using numerical rating scale for pain Performance of non-medicinal treatment according to the step-scheme of pain relief Clarification of prerequisites for the application of medicinal pain relief through the emergency-call physician 40 / 60

41 6.1.8 Correctly perform the administering of appropriate analgesia via medical teleconsultation (integrated in a WTG-related scenario by using a telecommunication system) ELEMENT FURTHER POSSIBLE MEDICATION The instructor shall explain and demonstrate: The general requirements for application of medications in casualties The knowledge of the action and side-effects of medication, as far as available for EFA Clarification of prerequisites for the application of medication after release through the emergency-call physician Delegates shall be able to demonstrate: Correct management of medication administering through the use of medical teleconsultation LESSON 7 - THEMES 80 min. This lesson presents 5 themes (situations or factors) that may significantly affect the response and management of First Aid incidents in Wind Turbine environments. The aim of this lesson is to give the Delegates the knowledge, skills and understanding presented in one of the 5 themes. The course Instructor shall select one of the 5 themes to teach during the EFAR Training. Theme 1 - Psychological effects of First Aid: To successfully complete this EFAR Module Theme 1, Delegates shall be able to demonstrate: (1) Knowledge of how administering (Enhanced) First Aid during an incident psychologically affects the Enhanced First Aider (2) Knowledge of how to give psychological (Enhanced) First Aid to the Enhanced First Aider (Person administering Enhanced First Aid) Immediately after an incident (short-term impacts on the Enhanced First Aider) 41 / 60

42 After an incident (long-term impacts on the Enhanced First Aider) (3) Knowledge of tools an Enhanced First Aider can use to evaluate whether they can give psychological (Enhanced) First Aid or if they need to contact professional help (4) Knowledge of where Enhanced First Aiders can receive psychological help (company-specific internal and external psychological help) Theme 2 - Sudden sickness and environmental factors: To successfully complete this EFAR Module Theme 2, Delegates shall be able to demonstrate: (1) Knowledge of and skills for responding to sudden sickness and environmental factors, that affect the central nervous system (2) Knowledge of and skills for responding to sudden sickness and environmental factors that affect the respiratory system (3) Knowledge of and skills for responding to sudden sickness and environmental factors that affect the circulatory system Theme 3 - Types of trauma: To successfully complete this EFAR First Aid Module Theme 3, Delegates shall be able to demonstrate: (1) Knowledge of and skills for managing and responding to trauma incidents that affect the central nervous system (2) Knowledge of and skills for managing and responding to trauma incidents that affect the respiratory system (3) Knowledge of and skills for managing and responding to trauma incidents that affect the circulatory system Theme 4 - Incident management and situational awareness: To successfully complete this EFAR Module Theme 4, Delegates shall be able to demonstrate: (1) Knowledge, skills for and understanding of incident management and situational awareness in a wind turbine environment, onshore (2) Knowledge, skills for and understanding of incident management and situational awareness in a wind turbine environment, offshore 42 / 60

43 Theme 5 - Complex incidents with several (2-5) casualties: To successfully complete this EFAR Module Theme 5, Delegates shall be able to demonstrate: (1) Knowledge of and understanding for managing and effectively carrying out Enhanced First Aid during complex incidents with several (2-5) casualties in a wind turbine work environment (2) Knowledge of and understanding of situational awareness and psychological effects of managing and administering Enhanced First Aid during complex incidents with several (2-5) casualties in a wind turbine work environment ELEMENT THEME 1: PSYCHOLOGICAL EFFECTS OF (ENHANCED) FIRST AID The Instructor shall explain and demonstrate: Psychological effects of administering (Enhanced First) Aid for Enhanced First Aider (person administering Enhanced First Aid) Psychological consequences of administering Enhanced First Aid Post-Traumatic Stress Disorder (PTSD) after administering First Aid Tools First Aiders can use to minimise psychological impacts of administering First Aid Where Enhanced First Aiders can receive help for coping with psychological effects (including PTSD) of administering Enhanced First Aid How Enhanced First Aiders can evaluate whether they can administer psychological (Enhanced) First Aid or if they need to contact professional help Delegates shall explain and demonstrate: Psychological effects of administering (Enhanced) First Aid for Enhanced First Aider Psychological consequences of administering (Enhanced) First Aid PTSD after administering First Aid Tools First Aiders can use to minimise psychological impacts of administering First Aid 43 / 60

44 Where Enhanced) First Aiders can receive help for coping with psychological effects (including PTSD) of administering First Aid How Enhanced First Aiders can evaluate whether they can administer psychological (Enhanced) First Aid or if they need to contact professional help The Instructor shall facilitate debriefing: Psychological effects of administering (Enhanced) First Aid for Enhanced First Aider Review positive actions observed during exercise Suggest points for improvement ELEMENT THEME 2: SUDDEN SICKNESS AND ENVIRONMENTAL FACTORS The Instructor shall explain and demonstrate: Sudden sickness and environmental factors (e.g. chemical, air quality, dust, pollen, gases, poisonous animals, etc.) Most common First Aid conditions caused by local environmental factors found at the specific geographic work locations and workplace related hazards Most common First Aid conditions worsened by local environmental factors found at the specific geographic work locations Effects of alcohol and other medication/narcotics on physical and psychological performance Delegates shall explain and demonstrate: Sudden sickness and environmental factors (e.g. chemical, air quality, dust, pollen, gases, poisonous animals, etc.) How to respond to sudden sickness caused and worsened by environmental factors that affect the central nervous system How to respond to sudden sickness caused and worsened by environmental factors that affect the respiratory system How to respond to sudden sickness caused and worsened by environmental factors that affect the circulatory system The Instructor shall facilitate debriefing: 44 / 60

45 Sudden sickness and environmental factors (e.g. chemical, air quality, dust, pollen, gases, poisonous animals, etc.) Review positive actions observed during exercise Suggest points for improvement ELEMENT THEME 3: TYPES OF TRAUMA The Instructor shall explain and demonstrate: Types of trauma Most common trauma conditions caused by accidents at construction sites onshore and offshore Most common trauma conditions caused by accidents at service sites during operation and maintenance onshore and offshore Delegates shall explain and demonstrate: Types of trauma How to respond to trauma incidents that affect the central nervous system How to respond to trauma incidents that affect the respiratory system How to respond to trauma incidents that affect the circulatory system The Instructor shall facilitate debriefing: Types of trauma Review positive actions observed during exercise Suggest points for improvement ELEMENT THEME 4: INCIDENT MANAGEMENT AND SITUATIONAL AWARENESS The Instructor shall explain and demonstrate: Incident management and situational awareness How lacking situational awareness can worsen First Aid incidents and cause further harm How to manage First Aid incidents and preserve situational awareness offshore and onshore Delegates shall explain and demonstrate: 45 / 60

46 Incident management and situational awareness How lacking situational awareness can worsen First Aid incidents and cause further harm How to manage First Aid incidents and preserve situational awareness offshore and onshore The Instructor shall facilitate debriefing: Incident management and situational awareness Review positive actions observed during exercise Suggest points for improvement ELEMENT THEME 5: COMPLEX INCIDENTS WITH SEVERAL (2-5) CASUALTIES This theme allows Delegates to gain knowledge, skills and practical experience with managing and administering First Aid during complex incidents with several (2-5) casualties. For this theme the Course Instructor shall divide their Delegates into three (3) different groups with roles shown in the table below: During this exercise the following shall occur: The Observational, First Aid and Casualty Groups give each other feedback on the incident management, First Aid performance and situational awareness during this exercise The instructor leads and supports the group discussion and gives personal feedback on the incident management, First Aid performance and situational awareness during this exercise The exercise is repeated, switching the participants of each group. Each Delegate shall participate at least once as a member of the Observational, First Aid and Casualty groups The Instructor shall explain and demonstrate: Complex incidents with several (2-5) casualties in wind turbine working environments Difficulties and challenges of managing and administering First Aid during complex incidents with several (2-5) casualties Situational awareness and psychological effects of managing and administering First Aid during complex incidents with several (2-5) casualties Systematically and effectively managing complex First Aid scenarios during complex incidents with several (2-5) casualties The Instructor shall lead the discussion on: 46 / 60

47 Complex incidents with several (2-5) casualties in wind turbine working environments Positive observations and constructive criticism for Delegates performance during this exercise with several (2-5) casualties How Delegates can manage and administer First Aid more effectively and efficiently during complex incidents with several (2-5) casualties Delegates shall explain and demonstrate: Complex incidents with several (2-5) casualties in wind turbine working environments How to manage and administer First Aid during complex incidents with several (2-5) casualties Situational awareness, knowledge and understanding of psychological effects of managing and administering First Aid during complex incidents with several (2-5) casualties How to systematically and effectively manage complex First Aid scenarios during complex incidents with several (2-5) casualties Delegates shall explain and discuss: Complex incidents with several (2-5) casualties in wind turbine working environments Positive and negative points of the Observational, First Aid and Casualty Groups performance and incident management during these complex incident exercises with several (2-5) casualties How to improve the Enhanced First Aid Groups performance with regards to administering First Aid, situational awareness and incident management for complex incidents with several (2-5) casualties using their background knowledge of First Aid. The Instructor shall facilitate debriefing: Complex incidents with several (2-5) casualties in wind turbine working environments Review positive actions observed during exercise Suggest points for improvement 47 / 60

48 LESSON 8 - SCENARIO-BASED TRAINING 245 min. The aim of this lesson is to refresh and build on Delegates previously acquired knowledge and skills to be able to assess, assist and provide correct Enhanced First Aid during an incident. To successfully complete this EFAR Module, Delegates shall, through different scenarios, be able to demonstrate: Managing incidents - approaching and assessing incidents Providing the necessary life-saving First Aid in an incident Correct use of basic and advanced First Aid equipment Knowledge and skills for AED safety procedures and correct use of an AED After the course, the Delegates will have the attitude to: Act as a leader in first aid situations Administer safe, effective and immediate lifesaving and enhanced first aid measures to save life and give assistance in remote areas using advanced emergency equipment and medical teleconsultation, while having particular regard for personalprotection ELEMENT PRACTISE FIRST AID TECHNIQUES The Instructor shall explain: Safety procedures in the training area Delegates shall practise and demonstrate: Safe life - saving First Aid techniques through relevant scenarios according to the Control Measures Form The Instructor shall ensure that: Following topics are covered during scenario-based training: Managing incidents using medical teleconsultation Providing necessary life-saving First Aid Correct use of First Aid and advanced emergency equipment 48 / 60

49 Knowledge of and skills for AED safety procedures Correct use of an AED and airway management devices This scenario-based training shall be conducted as group work with one or more Delegates as First Aiders, while the other Delegates act as casualty/casualties or observer/s. Each Delegate shall, as a minimum, act as First Aider at least one time. Relevant normal and advanced First Aid equipment shall be available and used at all times during scenario-based training. To ensure all of the above mentioned points are covered during scenario-based training, Training Providers shall combine several of the following First Aid situations mentioned below. At least one scenario must be based on an electrical incident: First Aid situations Dropped object - serious head injury, unresponsive, breathing Fall from heights - external bleeding, unresponsive, breathing Serious internal bleeding Serious external bleeding Unresponsive with normal breathing Unresponsive, not breathing CPR using an AED Epileptic seizure Asthma Stroke (circulatory, respiratory, central nervous system, includes heat stroke) Serious burn Hypothermia Hyperthermia Crush injury Eye injury Electrical accidents minor/serious Amputation Minor incident escalating to a serious incident 49 / 60

50 The Instructor shall facilitate debriefing: First Aid situations Review positive actions observed during exercise Suggest points for improvement The Instructor shall facilitate debriefing: Complex incidents with several (2-5) casualties in wind turbine working environments Review positive actions observed during exercise Suggest points for improvement LESSON 9 - EVALUATION 15 min. The aim of this lesson is to summarise the EFAR Module and give the Delegates the opportunity to conduct an open-minded review of the training and the instructor. To successfully complete this EFAR Module, Delegates shall be able to demonstrate: Active participation in the evaluation ELEMENT SUMMARY The Instructor shall: Summarise the EFAR Module and give the Delegates final feedback ELEMENT EVALUATION Delegates shall: Conduct a written evaluation The Instructor shall: Give necessary feedback on the written evaluations ELEMENT TRAINING RECORDS The Instructor shall: Ensure that all Delegates are registered with a personal Delegate profile in WINDA and have provided their WINDA ID to the Training Provider prior to completing the training course. 50 / 60

51 1.7 Delegate performance assessment Assessment of learning outcomes: Delegates will be assessed according to the learning outcomes stated in Section 1.6 by means of direct observation and supplementary oral questions, where appropriate. The assessment shall be conducted during practical scenarios based on the wind turbine work environment. Each Delegate shall demonstrate the ability to deal with a casualty that is: (1) Unconscious (2) Requires CPR (3) A scenario as detailed in Lesson 8 The formal evaluation of knowledge of above scenarios shall be in accordance with the Practical Assessment Measures in Section - 3 (Measures). Training Providers shall have a documented procedure in place for dealing with Delegates not meeting the stated learning outcomes. 51 / 60

52 ANNEX 1 - CONTROL MEASURES FORM (TEMPLATE) Delegate full name as in passport: Delegate WINDA ID: Course module: Date of completion: Topics Violation of Assessment Measures 0-2 passed / 3 failed Instructor Remarks Scenario Organisation Aware of personal and group safety at all times Organises and utilises correct equipment for given scenario Organises individuals and groups as required Scenario Management Establishes and maintains control of the exercise scenario at all times Fully participates in the exercise scenario Follows instructions when required Demonstrates correct and safe First Aid exercise scenario 52 / 60

53 Knowledge, skills and understanding Applies subject knowledge correctly in given scenario Demonstrates understanding of subject Delivers appropriate first aid measures Total Marks 0-9 Pass PASS: FAIL: Fail Instructor Name (in CAPITAL letters) Instructor Signature Training provider 53 / 60

54 ANNEX 2 - MEDICAL SELF-ASSESSMENT FORM (TEMPLATE) YOUR PERSONAL HEALTH IS YOUR OWN RESPONSIBILITY. YOUR TRAINING PROVIDER SHALL NOT BE HELD RESPONSIBLE FOR ANY ILLNESS WHATSOEVER DURING OR AFTER THE TRAINING. I hereby confirm that I have read and understood the listed risks and potentially lifethreatening medical conditions and that I am physically and medically fit to participate in GWO Training. I hereby confirm that there is no factor that will inhibit or affect my participation in GWO Training. I agree to follow all instructions from the appointed Instructor for the duration of the GWO Training. Should there be any doubt regarding my medical fitness, the training provider will stop the training and seek a physician s advice. Name as in passport Delegate WINDA ID Course module Signature and date The following conditions could pose a risk, when you participate in GWO training Asthma or other respiratory disorders Epilepsy, blackouts or other fits Angina or other heart complaints Vertigo or inner ear problems (difficulty with balance) Claustrophobia/Acrophobia (fear of enclosed area/height) Blood pressure disorder Diabetes Pacemaker or implanted defibrillator Arthritis, osteoarthritis or other muscular/ skeletal disorders affecting mobility Known allergies (E.g. bee, wasps or spider stings / bites) Recent surgery Any other medical condition or medication dependency that could affect climbing or physical impact of climbing 54 / 60

55 ANNEX 3 - EFA GUIDELINE: RECOMMENDATIONS Introduction Wind turbines are placed in increasingly remote areas, away from established medical facilities both offshore and onshore. This can increase the time interval between the placing of an emergency/distress call and the arrival of professional emergency responders. The GWO Enhanced First Aid (EFA) Standard has been devised so that wind turbine technicians have an additional level of first aid training focused on stabilising and keeping a casualty alive until they are rescued. Purpose This training standard provides the foundation for the development of the enhanced first aid competencies. This document serves as a guideline for when and how GWO members should implement EFA-training and what special equipment wind technicians should be trained to use. The decision to employ enhanced first aiders should be the outcome of a medical risk assessment. To implement GWO Enhanced First Aid, the employer will need to have the following: EFA training EFA equipment Access to medical teleconsultation services When to implement EFA training GWO recommends that implementation of EFA training is based on a risk assessment (see table 1 below). In general, all First Aid (FA) requirements for a wind farm will be dependent on the specific activity being undertaken and an estimation of the likely time interval for either medical support to reach the site or for the casualty to receive medical support. Emergency calls and medical teleconsultation support system as a basic principle The company/employer emergency plan is a central component of the rescue chain, especially offshore. The employer must ensure that in the event of an emergency, it has established lines of communication between itself and any external emergency control centre or external facilities such as First Aid, emergency medical care, emergency rescue services and firefighting. All personnel must always be able to place an emergency call, from every workstation. In an emergency, rescue and first aid workers (employed or externally contracted) must be able to quickly respond to and access the scene of the emergency. 55 / 60

56 The employer is also obligated to ensure appropriate transport which may include public resources in specific cases. Onshore public emergency service facilities are usually available to provide qualified transportation; however, this may not the case with offshore. Delivering EFA must be supported by company/national arrangements ensuring a system for medical teleconsultation: It is a recommendation that the employer has a robust telecommunication system - enabling medical teleconsultation support for EFA. The term 'Teleconsultation' in the context of administering basic and enhanced First Aid should be seen primarily as guidance, support and assistance provided by an emergency-call physician to all first aiders and medical assisters in emergencies (Fig. 2). The goals of teleconsultation are to achieve a qualitative improvement in First Aid and, in the context of enhanced first aiders, to extend the range of potential measures. As such, Teleconsultation should be understood as representing an additional structural element within the existing company rescue service capabilities, aimed at realizing a qualitatively high degree of patient care. EFA trained personnel provide a valuable component to meet this requirement. However, an enhanced first aider is not a medical professional and may have had limited real-life experience in providing medical intervention. Therefore, he/she will require medical teleconsultation and in severe cases support from professional medical responders. Figure 2 - Teleconsultation - support of (enhanced) first aid with respect to qualifications and approval of medication Teleconsultation can essentially be grouped into the following components: Supporting first and enhanced first aiders in carrying out First Aid measures Diagnosing and determining the indication status of the medical measures taken Monitoring and supervising the measures taken Providing individual as well as psychological support of the (enhanced) first aider Ensuring documentation and evaluation 56 / 60