Arolos Weyr

Healer

Entered by: Vicky
Email: vicky@orman.demon.co.uk

Catagory: People
Date: 2006-05-08

Relevant to: Arolos and DF

Summary: Bluffing your way as an RPG Healer. A reasonably comprehensive guide that will enable writers of Healers to feel confident about doing the right thing in responding to a cry for help.
Specifically what to do in being... First on Scene

Article: Bluffing your way as an RPG Healer

First on Scene;

Frequently in RPG'S characters fall afoul of some dramatic disaster or illness and there is usually a bellow for a Healer.
And if you are a Healer you are meant to go a-running and then prevent that poor character from dying. And as we should all know, the first responses can be vital.
This sequence is based on real emergency procedures, though they do change them frequently, but most of them are relevant and detailed enough that you can bluff your way as a Master Healer on an RPG.

Picture the scene, a call goes up - and your character is First on Scene. What do they do?

In any Emergency situation the first thing to do is notify the main authorities of a situation. On Pern, this would be the Healers. Your Healer needs to have things ready, expecting recovery by stretcher, or just set up in the Infirmary while they are performing the triage work. This means messages by any means possible.

The second thing that is done is to determine whether there is still a danger in the vicinty, or a hazard. If the person has been bitten by a venomous tunnelsnake and it's still crawling around ready to bite, this could be a problem! This is a general over all point that can encompass any environmental Hazard, such as Thread, or unsafe rockslide, or fire. Essentially the point is that your Healer and the patient stand little chance of survival if this is not taken care of before everything else. You can't fix a person if rocks are going to fall on them, or they still have live thread on them etc. The hazards of a situation have to be contained first.

Next up is Assessment.
If the victim is conscious that makes things easier. It is when they are unconscious that your healer will have a problem. Either way the healer should start talking to them, asking if they can hear them, what their name is and so on. This is proven to help in bringing them around and focused.
The usual sequence here is to check if the airway is clear first (usually accomplished by tilting the victims head back to straighten the airway and having a rummage around in the mouth if there are signs of vomit or a blockage), then see if they are breathing (by putting the ear to their mouth, or back of the hand as that is weirdly sensitive to slight breezes) and if there is no breathing then you check for their circulation/pulse. This is done by pressing two fingers to the side of the neck (or wrist, but neck is the main area). Your Healer will have to press pretty hard and shouldn't use a thumb. You have a pulse in your thumb that can give a false reading if you use it.

In the eventuality of there not being a pulse, the healer can attempt resuscitation. Chest compressions, and breathing into the mouth, on a five to one ratio (if there is someone else there) or a fifteen to two ratio (on your own). Things to bear in mind here - It is VERY easy to bruise and crack ribs as part of this process. This of course being preferable to being dead! Secondly, the airway has to be straight and it takes a fair amount of effort to do either. The Healer who is doing the chest compressions may end up with cramped and bruised hands themselves, and the breathing is conducive to hyperventilating. Sometimes a precordial thump is enough to get things going, which essentially hitting the patient very hard over the heart area.
Assuming the heart is going and they are breathing you move on to the next stage.

Assessment Examination.
The Healers next trick is to perform a rapid examination of the patient. They will be looking for source of injury, distress, and causative factors - a fancy way of saying, now, what's the problem?
The clues will be in the immediate symptoms. Gushing blood is usually a give away to an injury, but it is important to note what type of blood it is and how it is moving. Spurts that literally fountain are a clue that an artery has been hit - the blood is usually a very dark red. Venous blood pulses a little more weakly and is a brighter red and is generally less serious.
The principle first aid response to this is to apply pressure to the area - a Healer with a kit will usually find a hasty dressing and bandage it on. If it is an arterial hit - and that would be obvious from the way a dressing is being saturated immediately - then a torniquet should be used.
There's often talk of torniquets being used but they really are a last resort. There is the chance of a lost of limb because a torniquet essentially works by crushing blood supply, which can lead to gangrene and all sorts of fun. But in an arterial rupture, or loss of limb there is no other choice, otherwise the odds are the patient would be dead before the Healer got them to the Infirmary!

Torniquets are most effective in terms of venomous bites. Even so, they should be loosened at regular intervals, and retightened, to stop permanent tissue damage. The easiest means of applying one is using a belt. It's practically designed for the job.
There is debate about whether one method of helping bites helps or hinders. The cutting the wound and sucking the venom out approach has been shown to work if the cuts are carefully placed. Otherwise it stands to make things worse! Healers will have to make their own judgements on that.

The rapid examination should reveal obvious problems like broken limbs, dislocations etc. They will look abnormally bent, out of position and frankly disturbing. In a First on Scene situation, it's not likely to be fancy treatment.

Basically the Healer should put the injured part in as natural a position as possible without causing undue pain to the patient. Then they should protect the injured part from further injury by applying splints long enough to extend well beyond the joints above and below the fracture - this should immobilise it. They should try and use firm material, such as a board, or a pole as a splint, or whatever is handy. If they are using rough splints like sticks, or things that your Healer has just ripped off of the nearest bit of furniture it is a good idea to have them pad the splints with clothing or other soft material to prevent skin injury. They should bandage the splints at the break and at points along the splint above and below the break and control any bleeding with more dressings.

For very serious fractures involving injuries to the body, neck or back, they should only move the victim when absolutely necessary and only when all injuries have been immbolised, splinted etc. If the patient has a suspected neck or back injury and must be moved, the Healer must try and find a way to make sure that the back, head and neck are in a straight line, preventing them from being twisted or bent during movement. Generally this is accomplished through through using a back board or a rigid stretcher... and then they can be moved. The basic reason is that movement can cause cause more damage that the injury. A person can break their back and yet have it heal and walk again IF there is no nerve damage. And the majority of nerve damage occurs from movement of the damaged area.

Weapon related injuries are more common in a society where knives are the weapon of choice. There is a fundemental rule. If the weapon is still in the wound, leave it there until it can be removed under controlled circumstances - it could be the only thing stopping the victim from bleeding to death. If it has already come out, the healer should revert to compression to get them by to the Infirmary as soon as possible. If the knife/weapon is lodged anywhere where there are apparent bubbles of blood around the wound then the healer should pack pressure in against the wound and try and stop air leaking into the body. That can be bad!

If someone has been glassed the pressure put on the wound should not be directly over the injury, but rather to the side of it. That will stop glass being pushed deeper into the wound.

Head injuries and concussions should not be under rated. If someone has been knocked out, they have a very good chance of having at the least a mild concussion. The rule is if someone has been unconscious they should go to the Infirmary even for observation. Immediate signs of a concussion are disorientation, dizziness, bad headpain, intolerance to bright light, one pupil being slower to respond to light than other, nausea, vomiting and passing out and drowsiness. The danger is that there might be a subdural haematoma brewing, or that if the patient goes to sleep they might go into shock and a simple knock to the head could become fatal.

For burns, Pern is better off than most in that the best thing to do would be for the healer to douse it with cool numbweed laced water. Not salve or anything at that stage and any dressing or covering put on it should be dampened otherwise it will stick to the exposed flesh and damage it further. The clothing around the burned area should be cut away and then they should be treated for shock.

A healer should ALWAYS look for signs of shock - the proverbial clammy skin, rapid weak pulse dizziness. This can be avoided by keeping the person warm and elevating their feet if that is appropriate. Shock is something that is of vital concern as it kills more people than direct injuries. A relatively minor injury can kill through shock as a patients vitals spiral out of control. Sometimes the only indication of internal bleeding in the early stages is shock, though there might be some evidence of bruising and a growing rigidity and pain in the injured area. Shock is not the act of being surprised or amazed, it refers to a medical phenomena of a suppression of vital functions and should not be underestimated.

Illness is another possibility in a First on Scene incident.
Someone in the process of having a heart attack can be conscious while it is occuring. Their lips are usually cyanotic - going blue to put it bluntly. Heart problems tend to do this, causing purple colourations or pale colourations and blueness to extremeties. Now, there are herbal pills that will keep the heart working - foxglove based for a start which most healers would have in a limited supply in an emergency kit.

If your healer has this happen out of nowhere with no emergency kit then there is a limited amount they can do. But they can encourage the victim to cough. Yes, regular deep coughing WILL keep the heart beating. There are also primary acupressure points on the thumb area that a hard press and massage will send nerve impulses to stimulate heart activity. It can often do enough to get them to the Infirmary and medicine.

Sometime choking can mimic this, and it is always worth checking the airway for blockages. If it is obvious that it is an obstruction then the Healer should move behind the victim, put there arms around their abdomen from the back, make one hand into a fist and then yank inwards and upward under the diaphragm. This will often dislodge a blockage. This is not something to do on young children and babies. That is more easily accomplished by almost tilting them upside down and slapping their back.
If this does not work an emergency tracheoctomy might be called for, but more on that elsewhere.

A patient might be showing signs of a high fever, which is usually a sign of illness. The heat and colour in that case would evident, and the main thing the Healer should do in this instance is check the patient for signs of know contagion. Such as Everrash marks, or identifying symptoms. If it is one of the known contagious diseases, that Healer will be responsible for setting up quarantine procedures immediately. Otherwise the best thing to do is get them with all haste to the Infirmary.

Coming across a patient that has had a seizure can be difficult. If they are looking flushed and feverish then the odds are that they have had a febrile seizure (temperature related). If that is the case, trying to cool them with water is the most effective first aid. Alternatively if they are seizures such as epiletic seizures, then the best thing to do is to get them lying down in a stable spot, clear the area of sharp and obstructive objects and to try and make sure their airway is not obstructed - and on occassion give them something to bite on. When the seizure passes, the person will be most likely exceptionally tired. A seizure can expend anywhere around seven days worth of energy in around three minutes. They should be then taken to the Infirmary as the danger comes from multiple seizures one after another.

Suspected appendicitis is another possibility a healer should look out for, especially if there is evidence of chronic pain in the stomach area. The usual progression of symptoms is a sharp pain in the right hand side, that then generalise across the whole stomach area along with a fever. There might be some rigidity and one of the real give aways is that when pressed in, it is very painful on the rebound rather than the push in. They should be taken to the infirmary right away and convinced to have surgery.

The possibility of being called to an impending labour or miscarriage is high, and will be dealt with separately in other articles.

These tips cover most of the non Thread related first on scene incidents a healer might come across, and with any luck should provide everyone with the confidence to get their healers out there bluffing their way through emergencies!

The Dragonriders of Pern� is registered U.S. Patent and Trademark Office, by Anne McCaffrey, used here with permission. Use or reproduction without a license is strictly prohibited.