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Emergency Training for S/m
Practitioners
by:
Jay Wiseman
Reprinted with Permission
A young woman is being hoisted in suspension bondage when the winch handle
slips from her Master's hand and she plummets back to the floor. A man strains
at the cuffs holding his hands above his head and the overhead eyebolt pulls
loose; he crashes onto the floor, and the heavy chain attached to his wrist
cuffs then crashes down upon him. A woman giving an intense whipping on a hot,
humid day becomes nauseated, pale, and sweaty. A man quietly waiting for a
lecture to begin at an SM club meeting suddenly slumps to the floor; the people
who go to his aid discover that he has no pulse.
All of the above are examples of actual emergency situations that have arisen
within the SM community. Of course, many, many more incidents have also
occurred. Indeed, when I'm asked to give an "SM for Beginners" talk,
one of my favorite observations is "we are talking here about an activity
in which it's common for two people to go off alone together, and for one of
them to tie the other very securely and then proceed to beat them with various
blunt instruments. Allow me to suggest the radical notion that doing this could
be dangerous."
There is almost no such thing as life without risk. As long as somebody has
something that they don't want to lose -- their life, their property, their
reputation, whatever -- then they face at least some degree of risk. Indeed, the
phrase "he's got nothing left to lose" indicates that someone could be
extremely dangerous.
So the bad news is that almost all of us, no matter how quietly we live, face
at least some degree of risk. For example, as I sit here in San Francisco
working on this article, there is at least a small chance that an earthquake
might strike. (Actually, some SM scenes were in progress when the last "big
one" struck the Bay Area in 1989, and we learned a number of valuable
lessons thereby. More on those lessons in a later article.) The good news is
that it's possible, with only a modest amount of effort, to prepare ourselves to
respond effectively to most emergency situations.
All SM play involves some risk. Indeed, exploring that risk is part of SM's
attraction for many people. Exceptionally risky play, such as playing with real
firearms or with strangulation, is not necessarily irresponsible play, as long
as the players understand and are both physically and emotionally prepared to
deal with the degree and type of risk they are taking. On the other hand, to
play while ignorant or heedless of the risks involved may get you nominated for
"the Darwin Award." (When all is said and done, we all bottom to
Master Charles Darwin.)
Proper emergency preparation depends on having a somewhat informed
understanding of exactly what an emergency is. The word "emergency"
derives from the infinitive verb "to emerge" and is defined in one of
my books for ambulance crews as "the sudden and unexpected appearance of a
situation in which life and/or property is in jeopardy and in which the
rendering of immediate assistance is essential." In other words, some set
of unexpected circumstances has literally "emerged" that has placed
life and/or property in danger, and somebody needs to immediately do something
about that.
I've found that almost all emergencies fall into one of three categories:
- Behavioral emergencies which involve violence, other criminal activity, or
mentally unstable behavior.
- Environmental emergencies which involve fire, power failure,
earthquake, and similar occurrences.
- Medical emergencies which involve matters such as heart attacks,
seizures, and trauma.
A well-prepared SM practitioner will have at least a fundamental
understanding of all three types of emergencies, and will be both trained and
equipped to respond to them. In this article, I'll mainly cover where and how to
obtain the basic training and education one needs to evaluate and cope with
SM-related medical emergencies. In a follow-up article, I'll cover details of
how to treat common SM-related conditions.
There are three general categories of medical emergencies. Those that can be
handled without professional assistance such as a minor muscle strain; those
that need prompt, but not emergency, professional assistance such as a
superficial laceration on the arm, and those emergencies which require
emergency, professional assistance such as a heart attack. A knowledgeable SM practitioner
will be able to determine which type of emergency they are dealing with, and
will be able to respond accordingly.
One of the most useful concepts to keep in mind is that the goal of all
emergency care is to stabilize -- to turn an unstable, dangerous
situation into a stable, safe situation. Indeed, one of the most useful
questions you can ask yourself in any emergency is "what needs to be done
to stabilize this situation?"
Therefore, as a general rule, you should seek or call for help when the
resources you have available are not adequate to stabilize the situation. For
example, on one end of the severity spectrum, you would probably be able to dig
out a shallowly located splinter without any help. On the other end of this
spectrum, dealing with a cardiac arrest would probably be beyond your
capabilities and it would be time to call 911.
There are two books in print which do a very good job of educating people
regarding how to evaluate a wide range of medical symptoms, when and how to
attempt self-care, when to schedule a doctor's appointment, and when to call
911. The first is the Healthwise Handbook (eleventh edition) by Kemper,
McIntosh, and Roberts, published by Healthwise, Inc. International Standard Book
Number (ISBN) 1-877930-04-0. This highly popular book has been in print since
1975 and has won an American Health Book Award.
The second book is "The American Medical Association Guide to your
Family's Symptoms." It's edited by Drs. Clayman and Curry, and published by
Random House. ISBN # 0-679-74128-3. This book, formerly titled "The
American Medical Association Home Medical Advisor," is perhaps not as good
regarding self-care measures as the first book, but contains an outstanding
series of flowcharts that make it a superior aid to evaluating what various
symptoms may indicate. I strongly suggest that you make at least one of these
books, and preferably both of them, part of your permanent library.
You can learn a lot about self-care methods for less severe conditions from
the above books, and from other resources that I'll mention later. However, to
learn how to care for the more severe conditions, you'll need to take an actual
class in First Aid and CPR.
Before we go into those details, let's take a look at who will show up at the
scene of a major emergency. The players in this little drama are the victim, the
bystanders, the first responders (typically police officers, fire fighters,
lifeguards, factory medics, and others), the ambulance crew, and the hospital
emergency room staff.
All emergency medicine is something of an exercise in passing the buck. The
job of the bystanders is to try to keep the patient alive until the first
responders get there. The first responders try to keep the patient alive until
the ambulance crew gets there. The ambulance crew tries to keeps the patient
alive until they reach the emergency room, and so forth.
The person who plays the biggest role in determining how this drama ends is
the victim. They make most of the decisions regarding their own health, and
their actions play the leading role in determining the outcome. For example, if
a chest pain patient is going to suffer a cardiac arrest, they will probably do
so within the first two hours after the symptoms start, yet the average chest
pain patient waits over three hours before calling for help.
The person who plays the next-biggest role in determining the outcome of an
emergency is anyone else who happens to be in the area when the emergency
occurs. These are commonly called bystanders and, if they attempt to render aid,
are sometimes more formally referred to as "citizen responders" or, in
the United Kingdom, as "first aiders."
The most important tasks of a citizen responder are to recognize severe
emergencies for what they are, promptly call the Emergency Medical Service
(EMS), and keep the victim alive until the emergency crews arrive.
In the average urban or suburban area, the first responders will probably
arrive on the scene within about five to fifteen minutes of being called, with
the ambulance crew arriving soon after that. Therefore, citizen responders have
the greatest need to intervene in those conditions which will kill the patient
before the first responders arrive. Five such conditions account for almost all
such deaths, therefore good first aid training for citizen responders will place
the most emphasis on dealing with these specific conditions.
These five conditions are:
- an airway that has been blocked due to obstruction by the tongue or a
foreign object,
- stopped breathing,
- cardiac arrest,
- severe bleeding, and
- a severe allergic reaction.
Of these five conditions, it is cardiac arrest, usually secondary to a heart
attack, that is by far the most common cause of death.
A number of resources probably exist in your community that can provide
adequate First Aid and CPR training. You can get a good idea of what's available
by checking your local yellow pages under "First Aid Instruction" and
"First Aid Supplies." Almost all of such training will be given by
instructors authorized through one of the following four agencies:
- the American Red Cross,
- the American Heart Association,
- the National Safety Council and,
- Medic First Aid.
Of these four agencies, the one most likely to offer readily accessible
"off the street" training to the average citizen is the American Red
Cross. (If you ask around your local SM club, you may find that there is an
"in house" instructor and perhaps an "all-perv" class can be
organized. I teach several such classes every year in the San Francisco Bay
Area.)
The "gold standard" of training in First Aid and CPR for the
average citizen is the American Red Cross class called Standard First Aid. This
class is about six and one-half hours long, and covers all five topics listed
above plus some additional material. Most Red Cross chapters offer it several
times every month. As of this writing, the typical fee is about $50.00 per
student. Reduced cost and even free classes are sometimes available. Students
who successfully complete the course receive an "Adult CPR" card
considered good for one year and a "Standard First Aid" card
considered good for three years. (I recommend that people retake the entire
class once a year.)
If you help care for infants or small children, you would also want to ask
about obtaining training in infant and child CPR. The techniques used on these
smaller victims are somewhat different.
Good further training would include how to do two-person CPR and how to
perform mouth-to-mask breathing. These topics are covered in the Red Cross class
called "CPR for the Professional Rescuer" and the American Heart
Association class called "CPR for the Healthcare Provider." The latter
class textbook, and maybe the class itself, also covers how to use cricoid
pressure to prevent an unconscious person from regurgitating and aspirating
vomitus - a very useful technique to know. The textbook for this class is the
American Heart Association's "Textbook of Basic Life Support for Healthcare
Providers" (ISBN # 0-87493-615-2) and it does a very good job of outlining
how to care for various cardiopulmonary emergencies, including cardiac arrest,
heart attack, and stroke. I strongly recommend that you add this book to your
library.
The Red Cross offers both basic and more advanced training. If the idea of
getting some comprehensive training in managing medical emergencies appeals to
you, then ask your local Red Cross chapter when their next first responder class
(called "Emergency Response") is being offered. In this class, which
is roughly fifty hours in length, student first responders learn how to perform
a comprehensive assessment of a patient (including how to take their blood pressure),
how to perform both basic and advanced CPR techniques, how to manage a wide
variety of injuries and medical emergencies, and even how to deliver babies.
Many first responder courses also include instruction in how to administer
oxygen, and some even teach how to shock a stopped heart back into beating.
I need to make a brief advisory about instructor quality here -- namely that
quality of instruction can vary wildly from one instructor to another, and
entirely too many instructors do a very poor job. I've been an instructor for
over sixteen years, for a number of different agencies. Based on this
experience, I can tell you that, despite very strident official claims to the
contrary, there is an almost complete lack of quality control in this field -
and it shows. Indeed, one of the worst instructors it was ever my misfortune to
co-teach with was himself a very senior instructor-trainer. This person was in
charge of training instructors, and those instructors were then turned loose to
teach on their own with almost no follow-up supervision, and yet he was nothing
short of a babbling, rambling disaster. The quality of instructor he produced,
and the quality of students that they went on to produce, do not lend themselves
well to calm contemplation.
As a rule, you should try to find an instructor who has at least one year of
full-time EMS experience, or its equivalent, and who has been trained to at
least the paramedic level. However, I've known instructors who met both of these
criteria who nonetheless did very poor quality work. I've also known (a few)
instructors who met neither criteria and yet who did very good quality work.
A good instructor will explain things clearly and will not try to bluff their
way through when they don't know the answer to a question you might ask. They
will teach in a calm, organized, positive manner, and after you have finished
taking their class you should feel somewhat more relaxed, more knowledgeable,
and more confident of your ability to handle an emergency.
If, after taking their class, you feel the instructor was disorganized,
dictatorial, or unduly negative in their approach, or if you now feel less
confident, confused, and more tense about your ability to respond to an
emergency, then you may have drawn a bad instructor and it's time to go looking
for another one (and to communicate your misgivings back to the instructor's
agency).
If you can't relate well to your instructor, at least concentrate on the
class video and any textbook that you are given. These are generally accurate
and relatively "instructor proof."
The "holy grail" of managing a medical emergency generally consists
of the following steps (minor variations are taught in different programs):
- Survey the scene. This involves making a general survey of the emergency
scene before you go running in to care for obvious victims. Make sure that
there are no life-threatening hazards to you before you go racing in.
- Call for obviously needed major back-up. In the event of a large fire,
multi-car crash, or similar situation, making sure that 911 really has been
called may be the most important action that a citizen can take.
- Control hazards (if possible). Putting out small fires, diverting traffic,
and taking similar measures help keep a bad situation from becoming worse.
If doing this is exceptionally difficult or hazardous, call 911.
- Gain access to the victim(s). Most of the time, gaining access will be so
easy to accomplish that one will hardly be aware of it being a separate step
in emergency care. However, if gaining access is exceptionally difficult or
hazardous, it's once again time to call 911.
- Provide for what's called "body substance isolation" (BSI). This
mostly means keeping gloves made of latex (or vinyl, or plastic) readily
available so that you can put them on in hurry. This is not a good time to
be getting people's blood, or other fluids, on you. (If you do get so exposed, immediately
wash off, or otherwise remove, the fluids. Some emergency personnel carry
foil packets containing nonoxynol-9 or a similar disinfectant for just this
reason. It's also crucial to get a medical consult promptly. Additionally,
please note that it's now possible to get immunized against both Hepatitis A
and Hepatitis B. Ask your physician about having this done before an
exposure occurs.)
- Perform what's called a Primary Survey. This involves rapidly assessing
the victim's level of consciousness, making sure that their airway is not
blocked, making sure that they are breathing, making sure that they have a
pulse, and checking for severe bleeding. If any life-threatening conditions
are found, they are treated at once.
- Have someone call EMS if that hasn't already been done. It's also an
excellent idea to send some people outside to help flag down the first
responders and the ambulance crew and then lead them to the patient.
The above actions are the essential ones for a citizen to perform. If
someone present has had more training, they might also do the following:
- Perform what's called a secondary survey -- usually consisting of getting
a history, checking the victim's pulse rate, respiratory rate, and perhaps
blood pressure, and performing a head-to-toe exam. They then might give
further care to any conditions that they find. The first responders and
ambulance crews receive extensive training in how to conduct a secondary
survey and how to treat what they find.
While you cannot properly learn emergency care from a book (CPR skills, in
particular, require that you practice them on a manikin in the presence of a
good-quality instructor), there is one book that makes a particularly good
post-class reference. It's the National Safety Council First Aid Handbook
(with William Shatner's face on the cover) published by Jones and Bartlett
Publishers. ISBN # 0-86720-846-5. I've looked over many first aid manuals, and
I'm particularly impressed with the organization and content of this one.
In summary, in this article I've described where and how to obtain the basic
knowledge and skills you will need to respond effectively to a medical
emergency. In my next article, I'll discuss how to deal with specific emergency
situations.
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Editor's Note: Jay Wiseman is probably best known in the SM community
as the author of the highly regarded book, SM 101: A Realistic Introduction.
He spent eight years as an ambulance crewman, including two years as director of
training for an ambulance service and four years in a ghetto. During this time,
he received the Red Cross Certificate of Merit for Lifesaving Action -- their
highest award. He also spent three years in medical school, during which time he
worked in an emergency room, a coronary care unit, and an intensive care unit,
and also became an American Heart Association instructor in Advanced Cardiac
Life Support.
He currently works full-time as a writer in health, relationship, and
sexuality issues, and is active in teaching various classes in basic, advanced,
and wilderness emergency care. He offers classes at both the citizen and first
responder level to the SM community of the San Francisco Bay Area, and has
recently become one of the very rare individuals ever nominated to receive a
second Red Cross commendation for lifesaving action. He can be reached by
sending e-mail to oldrope@aol.com or by
writing to 3739 Balboa # 195, San Francisco, CA 94121.
~~~~~~~~~~~~~~~~
Copyright © 1997 by Jay Wiseman, author of SM 101: A
Realistic Introduction. All rights reserved.
Copyright issues footnote: I wrote this article with the hope that it
would be widely read and distributed, and without any particular expectation of
financial compensation in return for writing it. Therefore, I consent to the
following uses of this essay:
- It's fine with me if you read it.
- It's fine with me if you send it, in unaltered form and including this
copyright issues footnote, in private e-mail to appropriate others.
- It's fine with me if you post it, as mentioned in point # 2, to newsgroups
and closed mailing lists.
- If you put it up on a private, no-fee-to-access, website, please put it up
as mentioned in point # 2 and include a link to the Greenery Press website (http://www.bigrock.com/~greenery)
and to the Submissive Women Kvetch website (http://members.aol.com/oldrope/).
- I do require that you get my specific prior permission before putting this
article up on a pay-to-access website, putting it in a book or periodical
offered for sale, or otherwise charge for any sort of access to it.
Page Updated
08/27/05
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