Why MIRA? Well I have been involved in several incidents during both my time in the military and private security incident. During the early days in the military first aid was taken for granted as something REMFS done, by everyone in my battalion, however once the Iraq and Afghanistan wars started I quickly realised how important first aid actually was and took part in as many team medic cadres and extra first aid training as I could. I completed FPOSi during the Phoenix CP course however after a year in the industry FPOSi is becoming more popular making it a little harder to make your CV stand out. I have been very proactive, completing courses both while I am away and while I am at home and decided that improving on my first aid would be a good way to give me that little extra edge towards gaining more employment in the future.
So why Exmeds MIRA? Well I had been looking at SOS Groups EMT B course based in Guatemala as I liked the look of the clinical attachment, however due to it being 3 weeks long and due to my rotation I wouldn't be able to fit it in. So I started looking at other options and I quickly noticed that MIRA was recognised by many of the big employers including G4S and CRG. Yes the course is only 5 days compared to the 20 of the EMT-B course but unlike the EMT course you need to have completed the 5 day FPOSi to be able to get a place on the MIRA course. So I booked onto Exmeds course for the first week of my leave. Upon booking the course I had to prove I had an in date FPOSi qualification by emailing them a scan of my certificates and then I received my joining instructions and a 144 page PDF file via email for pre course reading.
Monday - Day 1
Upon arrival at Pengethley Manor Hotel this is their new training area and we are the first course to use the facilities here, it is very impressive as it is a beautiful estate (There is accommodation provided here full board, I however booked myself into a Travelodge a little further up the road). I made my way into the reception where I was guided to a room with the rest of the students, where G10 desert boots, Craghoppers and The North Face bubble jackets/body warmers must have been on the packing list that I missed. The students were mainly cp with a couple maritime guys and a girl from the BBC.
The instructors took us to a class room where they introduced themselves and the course and what we could expect from the course. Their backgrounds were impressive, paramedics from the UK and USA, CMT1, anaesthetist/offshore medic and an aussie army medic. All of whom are current as Exmed rotate their instructors around through the various placements that they have around the world. We were given a very professional looking booklet/hand-out including all the course material, an Exmed pan and a little key ring with a face mask inside!
We then had to complete a short written assessment to check where our medical knowledge was.
Our lessons started with airways and the lesson was more in depth than anything I have previously done, covering the pneumonic COLMA and yes there was also surgical airways, and ended with a round robin of practical scenarios, one of which was on surgical airways using pig tissue. It was explained several times that this should only be used as a last resort. I found this really helpful as before I had only watched videos of this being performed or been taught it with an ex American sf soldier, obviously without the chance to practice it. We also had a chance to practice basics such as the chin lift on a real person, again something I've never had a chance to practice except on a dummy, again it was explained that basics done well can make the difference and things like the surgical airway are a last resort. We also had a practice using different types of airways, which ones to use and when aswell as how to measure up the casualty for the correct size.
After airway we moved onto breathing as per the pneumonic CABCDE. Again we went into more depth with this than I had previously done, another pneumonic FLAPS TWELVE was to be learnt, as we were going through subjects like flail chest, tension pneumothorax (this is no longer taught on military team medic cadres), emphysema etc learning how to recognise and treat them. Another good part was again using pigs, we were shown pigs lungs and shown what happens with sucking chest wounds and tension pneumothoraxâ€™s using clear plastic bags as the chest.
Tuesday - Day 2
Day 2 kicked off with some practical that we never had a chance to do the previous day. We practiced, auscultate and percussion which I had never done before. These are clearly important skills to have if you have to look after a casualty for any length of time before hospital treatment is available, as they can help diagnose various chest problems. We also practiced other breathing skills such as using the bag and mask to help someone breathe before we moved onto needle decompression. Needle decompression is something that I have had lessons on before during my time in the military with an American sf soldier, however I never had the chance to practice it. We were taken through it on a dummy, which was good as it isn't really a hard procedure to do, but before I would never have had the confidence to do it.
Circulation was next on the agenda, covering tourniquets, Israeli dressings and fluid therapy. Again, this was taken in a round robin type class in small groups. The tourniquet and dressings were the same as my military training and drills that were used during my time in Afghanistan. The fluid therapy was new to me, and enjoyed the practical sessions, again practicing IV and F.A.S.T.1. on dummies. During the practice sessions we were constantly reminded when to use fluids and that their use could be dangerous, and that the course was developed for Remote Areas. I know that some medical practitioners look down on lowly people of my calibre using such techniques, however working in the maritime security industry I may not have the luxury of having a paramedic/doctor with the relevant skills and equipment to save the casualty for hours or even days, so learning these skills and how and when to use them safely and correctly, could indeed save someone's life, if I can keep them alive until further medical assistance can be provided.
We finished off day 2 by going through a scenario in our groups, with a dummy casualty and swapping first aiders to keep everyone thinking.
Wednesday - Day 3
Day 3 began with drugs, we learnt about several types of drugs their doses and when to give them. It was emphasized that we would need to check with our employer that we would need to check if we are legally allowed to administer any drugs that they had provided in the med kit. This section is clearly something that would need a lot of revision as it's so important to get this right, as any mistakes could potentially be fatal.
The next subject to be covered was head injuries, where we covered pupils with the pneumonic PEARL as well as a reminder on things from FPOSi such as checking for skull fractures etc. We then touched on burns and medical conditions again as a reminder to the FPOSi course with a little extra including giving fluids to a burn victim and the Parkland Formula for that, and then going over diabetes, epilepsy, anaphylaxis and asthma.
The day was finished off by moving through several scenarios in groups of four, where we took turns being the medic/TL and treating casualties in various different incidents.
Thursday - Day 4
Revision from the previous lessons was first today, where we were getting asked lots of questions on all the subjects covered. After the revision there were lessons on environmental injuries, both hot and cold, before we broke for lunch.
After lunch we moved to an RTA scenario where we learned how to safely cut the roof off a car and remove a casualty, using only basic equipment which consisted of a wood saw and a hack saw. Both of which do not take up much space and can be packed into vehicles before your expedition starts. This was a good practical lesson, not something aimed at HE CP, but could be useful for incidents in other remote areas such as south America or Africa.
There was then another break where we could revise or practice any skills or drills with the instructors on hand, while we waited until later for the practical scenarios later in the evening.
The practical scenarios consisted of us splitting into groups and then attending the scene of a 'plane crash'. There were real amputees acting as casualties with all the make-up, fake blood etc. Using the real amputees as I had done in the military was good, the girl from the BBC who was in my group looked a little shocked at the fact though! We treated the casualty as we would unless we wanted to do any surgical airways where we were taken to a pig throat to carry out the technique or IV where we were taken to a prospetic arm with blood in the veins, where we carried out that technique.
Afterwards there was a BBQ that we were all invited to (previous days only lunch had been included in the course price). After the BBQ it was time to retire and revise for the tests tomorrow!
Friday - Day 5 - Test day
Test day kicked off with some revision, one of the instructors went round the class asking various questions, before we were split down into 2 groups, one group doing the written test first and one group doing the practical test first.
I was doing the practical first. Set out similar to a military team medic cadre, I went to the area outside where I collected my med bergan and made my way to a casualty after being briefed by the examiner. I was part of a patrol in Afghanistan when my client had been shot, then he fell into a wadi. I assessed the scene and sent an ETHANE report before moving in and seeing that Injuries sustained were a catastrophic bleed to the upper left leg to which I put on a tourniquet, straight away before moving onto ABCDE. On B I noticed that he also had a tension pneumothorax probably sustained from the fall so needle decompression was needed. He also had a suspected head injury due to his pupils responding slowly to light. After successfully treating the casualty it was onto the written exams. The first was around 100 questions long with the pass mark set at 70%, the second included watching videos and answering questions on them, including what injuries we would expect to find and what treatments we would give.
After everyone had passed, including those who needed retested, we were given a good closing brief and were told that if we had any questions, used first aid from the course, were looking to buy kit or do more courses to send them an email, even if it wasn't Exmed kit or courses.
Overall I thoroughly enjoyed the course, and feel that I have benefited from it by improving my first aid skills. A friend on the circuit send me a Facebook message asking how I got on, and told me that for him it opened up more opportunities and said that employers liked the MIRA qualification. I know that having successfully completed this course does not make me a paramedic, however it is a good course for exactly what it is aimed at, TEAM medics, keeping someone alive until you can get them into hospital or medical care.