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Modular Program Planner Section 4

SECTION 4
SAFETY
INTRODUCTION
Section 4 is devoted to the various safety issues associated with organizing and implementing a sailing program. This chapter is separated into two distinct segments: prevention and procedures. The first segment is devoted to Risk Management (accident prevention) and the second part discusses Accident Management (emergency procedures). It is in your best interest to carefully
study this important module.

Sailing is an adventure activity and as such exposes people to risks they might not encounter in the normal course of life. As a sailing program organizer, you are the person ultimately responsible for insuring that your program is a safe one. If an accident occurs, you will be held accountable so make sure it is handled properly. Should a lawsuit be brought, you will probably be named. As President Truman said, “The buck stops here.”

The technical information presented is provided as a guide only. US SAILING makes no guarantee as to the ultimate accuracy of this technical information. It is the responsibility of each program organizer to seek the advice and counsel of their local emergency and safety organizations or American Red Cross chapter to insure that safety procedures and equipment meet latest standards and guidelines, as well as local law.

RISK MANAGEMENT (ACCIDENT PREVENTION)
SUPERVISION
The success and smooth operation of a sailing program is contingent on the overall supervisory structure that exists within the organization. it encompasses the actions of every instructor, aide and administrator. Each staff member should have specific duties and responsibilities in the instruction and care of all program participants.

Supervision falls into two categories: General Supervision and Specific Supervision. These are dependent on factors that include:
* age and skill level of the students
* type of activity
* environmental conditions

General Supervision is defined as maintaining surveillance over the entire group. When exercising general supervision, the instructor should be immediately accessible to all participants. The instructors should be constantly alert for deviations from normal procedure, potentially hazardous conditions, and be able to react immediately and appropriately to such conditions. While it may be impossible to see all participants all the time, that is the ideal for which to strive. The instructor should move about the area, being careful to maintain the best possible field of vision. Program participants should not be allowed out of sight.

Specific Supervision requires the instructor to be WITH the students participating in the activity.Specific supervision refers to the planning, direction and evaluation of an activity. Specific supervision must be provided for persons who, through lack of training, experience or maturity are unable to appreciate the risks involved in the activity, assess their own level of performance and/or understand and follow established safety procedures.

If an instructor has to divert attention from the overall supervision of the class to make a rescue, administer first aid, or effect a repair, the class must be watched by another instructor. Supervision cannot be left to chance or haphazard arrangement.

A system must be devised whereby constant supervision is maintained. The procedure to implement uninterrupted supervision should be understood by the entire staff.

Following are three helpful hints for providing continuous and proper supervision during an emergency situation:
1. Have an adequate number of instructors with each group in safety boats with radios.
2. Develop and rehearse emergency procedure Do’s and Don’ts.
3. Maintain emergency phone numbers and procedures checklist near phone.

Supervisory judgment encompasses a variety of circumstances in which one is required to use common sense or prudent judgment. Two areas that require careful supervisory judgment are the provision of proper first aid and the matching of students to activities. Failure in this responsibility can lead to injuries and subsequent legal action. The following guidelines, while not all—inclusive, will provide a format to structure program organization and as a result possibly reduce or prevent participant injury and the probability of subsequent lawsuits.

Protect your program from liability because it is 1) best for the students and 2) best for you. Safety must not be taken lightly. One serious accident may permanently disable someone or destroy a professional career.
 
TRAINING INSTRUCTORS
To ensure that your staff is able to property supervise any situation that might occur while they are on duty, specific training is required. This training falls into four categories:
1. Cardiopulmonary Resuscitation (CPR)
2. First Aid
3. Methods of instruction
4. Specifics of teaching sailing

A detailed description of CPR and First Aid training is discussed below. Training in methods of instruction and specifics of teaching sailing are available through US SAILING.

CPR Training
Cardiopulmonary resuscitation (CPR) training is available through many organizations, including the American Red Cross (ARC) or the American Heart Association (AHA) programs. These organizations administer educational programs similar in course content in regard to performing the psychomotor skill of CPR.

Certificates in CPR are generally valid for one or two years from the date of course completion and to be kept current must be renewed. CPR courses are available through the local ARC chapter, hospital, rescue/ambulance squad or unit, evening educational school, recreation department, church or civic group.

First Aid Training
There are three systems for earning a standard first aid certificate. The certification period for each program is the same; the certificate is valid for three years from the date of course completion. Of the three standard courses, the Standard First Aid-Modular System and the Standard First Aid and Personal Safety are the more encompassing and give a more detailed and
broader base of training with which to deal with first aid emergencies on land and in the water.

Multimedia Standard First Aid
This is an eight-hour program that uses demonstration films, a programmed workbook and practice sessions utilizing typical emergency situations and the appropriate first aid.

Standard First Aid — Modular System
This is a flexible, self—paced program that involves about 15 hours. The ten modules each covera specific topic:
* Emergency Action Principles
* Accident Prevention and Safety
* First Aid for Wounds
* First Aid for Burns
* First Aid for Injuries to Bones, Muscles and Joints
* First Aid for Specific Injuries
* First Aid for Sudden Illness
* Emergency Rescue and Transfer
* Bandaging

Standard First Aid and Personal Safety
Sometimes called “Standard First Aid—Lecture,” this 21—hour course involves a more traditional classroom format with demonstration and skill practice. The topics included in the course content are the same as those of the Standard First Aid—Modular System.

Advanced First Aid
Advanced First Aid is the Red Cross’ most intensive first aid course which includes the full range of first aid skills. It uses lectures, discussions, demonstrations and skills practice to achieve a “professional” level of proficiency. The time requirement of this program is approximately 53 hours with a certification time period of three years.

In addition to the above training, the entire staff should review and practice water rescue skills,
accident and emergency procedures.

SELECTION OF ACTIVITY
It is imperative that your staff take great care in selecting the appropriate activity for a class on a given day. Students should be grouped according to their:
* Level of skill and ability
* Size
* Age

These criteria should also be used to select the specific activity for the group. There is no such thing as a homogeneous group. Screening; pretesting and recording students’ past performance will help to create a safe and successful learning experience.
The instructor must consider other criteria such as weather and potential hazards when deciding how to conduct the class.

WEATHER
Weather conditions at sailing facilities directly affect the safety of the sailor. Conditions will vary greatly in different parts of the United States. Sailing instructors and program administrators must understand weather and local environmental conditions. The staff should monitor a weather radio throughout the day and be aware of visual storm signs as predictors.

This knowledge is enhanced by:
1. Local knowledge of predictable weather and cloud patterns
2. NOAA reporting
3. State and local weather bureau reports
4. Local airport conditions and predictions
5. Charts of seasonal weather activity relative to the club’s geographic location
6. Accumulation of newspaper weather charts over several weeks.

Once bad weather is predicted, staff members should be conservative and plan alternate activities to keep a class onshore.
A “clear the water” signal should be understood by all and responded to immediately. Guidelines for responding to lightning and thunder should be established and put into writing, since the frequency and duration of storms and the speed at which they travel vary in different locations. Action plans for severe weather such as lightning and heavy rain, hail and tornados should be
developed and practiced in the event of their occurrence.

SWIM/PFD CHECK
1. Tread water wearing usual sailing clothing
2. Swim 50 yards in sailing clothing
3. Get into PFD while treading water
4. Perform a task (tying or untying a knot) while wearing a personal flotation device (PFD)
5. Remove PFD while treading water

PERSONAL FLOTATION DEVICES (PFDs)
Personal Flotation Devices (life jackets) must be worn at all times when on or near the water. Type II or Type Ill life jackets properly rated to the individual’s weight must be worn b~ students and staff when participating in any activity that takes a person into a boat, on a dock, ramp, seawall or beach area that is adjacent to, leads alongside of or over water. Life jackets should be
properly identified with the owner’s name and should be inspected regularly to ensure that they are in good functioning condition (no missing snaps, torn zippers, exposed or waterlogged flotation). Life jackets that are unsafe or of questionable value must be discarded and replaced immediately.

FOOTWEAR
Sailing programs traditionally have left the issue of shoes to the instructor teaching the class, taking into consideration the site, weather and types of boat being used. From a safety as well as a liability viewpoint, this attitude is wrong. Shoes that cover the toes and encircle the feet must be worn at all times. This includes land activities as well as on-the-water work and involves
everyone – students, instructors, aides and program administrators. The concept of “Do as I say, not as I do” is an unacceptable way of conveying safety as an attitude.

SHOES MUST BE WORN AT ALL TIMES.
PROGRAM RULES AND REGULATIONS
Every waterfront area will need certain regulations. Keep the rules simple, to a minimum, and enforceable.

General Rules should include:
1. PFD’s worn and secured at all times
2. Wear proper footwear at all times
3. No running”-~.
4. No swimming
5. No pushing
6. No smoking
7. No alcohol
8. No playing on/near ramps and hoists
9. No glass jars or bottles
Helpful hints:
1. Familiarize instructors and students with rules.
2. If enforcing a rule, explain why.
3. Everyone must be accountable.
4. Be fair.
5. Be firm.
6. Post most important rules.
7. Post map showing off—limits areas.
SIGNS
Post signs to serve as a reminder of the most important regulations. Keep signs simple, useable and legible. Signs can include:
1. Wearing of PFD’s
2. Swimming regulations
3. Hoist/ramp procedures
4. Boat check-out procedures
5. Free sailing regulations
6. Access to storage/maintenance area
7. Occupants per boat

HAZARDS AND OFF-LIMIT AREAS
Prior to the start of the program, inspect the land base, equipment and sailing area. Determine if there are any hazards or off- limit areas. Design a map and/or chart which highlights these areas and identify areas where students are allowed.
1. Hazards
a) Rocks
b) Shoals
c) Power lines
d) Ramps
2. Off—Limit Areas
a) Office
b) Store room
c) Pool
d) Beach
3. Limited Access Area
a) Docks
b) Boat storage area
c) Sail locker
d) Restrooms
4. Unlimited Access
a) Classroom area
b) Designated lawn

EQUIPMENT CHECK/MAINTENANCE

Design a system that provides a periodic check of all equipment and procedures to fix anything that is broken. Some equipment – such as training boats and safety boat – will need a thorough review every day, while other apparatus – such as a hoist – can be eyeballed daily and serviced at regular intervals.

If a piece of equipment is broken, it must be repaired immediately. The staff should prepare a maintenance report for all equipment requiring repair. Also, a maintenance log must be maintained. This log should keep track of the condition of all equipment dates and times of its last check and, if pertinent, the type of repair made.

To help your staff keep up to date and proper maintenance records, devise several simple forms they can use to report the condition of equipment and any repairs that were made.

SAFETY BOAT SKILLS
Every instructor must pass a safety boat skills test before they are allowed to operate the safety boat for instructional purposes. Additionally, every instructor must be checked out on any of the safety boats they will use during their term of employment.
A safety boat Skill Test and Safety Boat Checklist follow.

RADIOS
A radio system is an integral part of a sailing program. Radios provide a means of communication between safety boats and a link between the safety boats and your land base. The procedures for proper use of this important equipment should be reviewed with the staff. Specific guidelines governing the use of radios must be established and followed by the instructors.

There are pros and cons to each type of radio system. Cost and licensing are just two considerations. Choose a system that enables you to communicate with other water-based organizations in your area: police, Coast Guard, harbor patrol, marina, clubs, etc.

There are two basic systems to consider: CB and VHF. Both systems are governed by the Federal Communications Commission (FCC).
 CB
 You can use Citizens Band (CB) radios without a radio operator’s license or permit. You do not have to give call   letters or keep records of your transmissions.
 
 VHF
 It is very likely that you will choose a Very High Frequency (VHF) marine radio operating within the 156 to 162   megahertz frequency range. Most boats, sailing clubs, boatyards and harbor masters use these VHF radios. Every   VHF radio transmitter must have a station license which is applied for using FCC Form 506.

 Hand-held VHF two-way radios are usually operated as mobile units of a yacht or shore based VHF station license.   To operate a VHF radio legally you must be at least 14 years old and you must have an FCC restricted radio   telephone operator permit (RP). You can apply for your RP with the FCC. There is no test required and the RP is   issued for your lifetime.

 If the boat radio station license is yours, you must keep a log, and you cannot transmit if your boat is on land or on a   trailer. You must give the FCC call sign of the station you are transmitting from at the beginning and end of each  message.

The following operating procedures are taken from FCC Rules and Regulations, Part 83:

Operating Procedures
83.1019 (VHF Marine Rule 19) How do I call another boat?
Speak directly into microphone in a normal tone of voice – speak clearly – distinctly.
a) Make sure your radio is on.
b) Select Channel 16 (156.8 MHz) and listen to make sure it is not being used.
c) Press the microphone button and call the boat you wish to call. Say:
(Name of boat being called)
This is (your boat’s name and call sign)
d) Once contact is made on Channel 16, you must switch to a ship-to-ship channel (see Rule12).
e) After communications are completed, each ship must give its call sign and switch to Channel 16.

83.1020 (VHF Marine Rule 20) How do I place a call through a public coast station?
Speak directly into microphone in a normal tone of voice – speak clearly – distinctly.
a) Make sure your radio is on.
b) Select correct channel for the public coast station, and listen to make sure it is not being used.
c) Press microphone button and say:
(Name of coast station)
This is (your call sign)
d) When coast station operator answers, say:
This is (name of boat call sign and billing number if assigned)
Placing a call to (city, telephone number desired)
Inform operator of type of billing desired.
e) After completion of call, say:
(Name of boat, call sign) “Out.”

Finally, it is a good idea to maintain a radio log at the land base. Entries should include:
1. Date
2. Time
3. Unit or station contacted
4. Nature of call
5. Time call was completed

SAFETY BOAT CHECKLIST
1. Weather forecast
2. Tidal predictions
3. Up-to-date charts on safety boat (Note: The U.S. Coast Guard’s Notice to Mariners continuously reports changes on charts.)
4. Compass
5. Fuel onboard
6. Firefighting equipment as per U.S. Coast Guard regulations
7. Basic equipment onboard: PFDs, engine tools and spares, oars/paddle, tow lines, anchor and anchor line
8. Drain plugs securely fastened
9. Bilge pumped out
10. Outboard engine is in correct down position
11. Blower on before starting
12. Follow starting instructions
13. Check water discharge on watercooled engine
14. Warm up engine for 1-2 minutes

SAFETY BOAT OPERATION SKILL TEST
1. Start test with the boat moored to a dock, all systems off, fuel line disconnected or shut off.
2. Get boat underway, having made all checks on the Checklist.
3. Familiarize with throttle, shift and steering.
4. In open water, high speed and controlled speed boat handling as called by evaluator. Show particular awareness before, during and after turns.
5. Anchor boat, cast off anchor line with float attached to end of anchor line, return and recover anchor.
6. Driver, unassisted, secures boat to a mooring buoy by passing line through buoy and cleating back to safety boat.
7. Position boat upwind or upcurrent of buoy facing downwind/downcurrent. Hold boat close to buoy by coordinating throttle, shift and steering.
8. Rotate boat in own length with throttle, shift and steering.
9. Retrieve a free-floating PFD (to simulate a man overboard rescue).
10. Land alongside a moored boat and retrieve a PFD from moored boat.
11. Land facing downwind or downcurrent at a dock.
12. Turn boat around dockside using lines and fenders only.
13. Moor boat in starting position for long stay. Shut down engine and systems, disconnect or turn off fuel line, and stow all equipment.

ACCIDENT MANAGEMENT (EMERGENCY PROCEDURES)
EMERGENCY MANAGEMENT PLANNING
Emergency preparedness is an important part of the everyday management of any sailing program. In developing an emergency care procedure, every potential emergency must be considered. A list of potential emergency situations, ranging from the most likely to the remotely possible, must be identified and categorized. A plan of action should be developed for each entry on the list. Each plan of action should be as specific as possible, including detailed steps to- be followed for each situation.

Emergency preparedness must also include an ongoing educational program of the staff, students and club affiliates. Updated information, methods and procedures must be included in this training. Visual aids and printed handouts can be used to promote awareness of emergency procedures.

Emergency preparedness is a necessary daily function of the staff, management and participants of any boating facility. Emergency procedure action plans should be practiced regularly by the staff and all participants. Additional personnel that should be involved in the development and practice of emergency plans include local law enforcement and fire departments, rescue squads, gas and power companies, water authority agencies, marine patrol, Coast Guard units and, possibly, chemical supply companies. Each of these groups will have helpful information on emergency procedures. Methods and procedures can be updated by working with these groups.

The following approach is suggested when formulating an effective emergency plan.

1. Organize - The chain of command within the organization should be defined and set down so that all persons clearly know and understand their role and responsibility within the structure. State and local ordinances should be checked so that facility standards, policies and procedures will conform to all ordinances.

2. Define - List every possible emergency situation at the sailing facility and analyze and define each situation as to cause, prevention and actions to be taken by each staff member. Conditions such as weather, number of boats and students, number of safety boats, staff members and any other influencing factors should all be considered. Past records of accidents and emergencies should be reviewed and analyzed. These records will give insight as to the causes of previous accidents and the action steps that were taken.

3. Plan – Develop a plan of action for each situation. Support personnel should be consulted and involved in the development of emergency plans. Emergency personnel who are expected to respond to a call should be given clear directions on how to approach the facility. This will allow for a smooth transition in the proper care for the injured person. Police, fire and rescue personnel can provide valuable information about response times, limits of authority and the amounts and types of assistance that are available.

An area should be designated for first aid care for all victims of accident or illness. When there is no danger of causing further injury to the victim, the person should be moved to the first aid area as soon as possible. The area should be private with easy access for rescue personnel. All staff should have access to the first aid area and the area should be clearly identified.

Each staff member should have primary and also secondary responsibilities to follow in the event of an emergency. These procedures should be rehearsed at least monthly.

All rescue and first aid equipment should be inspected and situated for easy access. The inspection should be conducted daily on opening the facility. Any equipment not in good condition should be removed and repaired or replaced. Arrangements should be made to replace all equipment and materials used during an emergency.
 
All rescue and accident cases should be reported and documented in writing. A system of records and reports should be developed. The staff must know proper procedures of filling out and filing accident reports.

In case of an emergency, the administration, management or board of directors of a sailing facility should designate one person to be responsible for informing the injured person’s family and for providing information and news releases. This eliminates the possibility of misinformation being released.

Crowd control is an important part of any emergency plan, whether on the water or on land. Students must continue to be supervised during an emergency. A coordinated program to provide this supervision and control must be established. Limits of authority for instructors and all staff should be clearly understood.
 
The success of any emergency procedure plan will depend on the ability of the participants to understand and carry out their assigned responsibilities. After a plan of action has been formulated, an educational program can be designed to meet the objectives of the plan. The training program for the staff should include these four elements:

1. Initial training in commonly expected emergency situations;
2. Review and practice of emergency procedures at regular intervals; records of which, including dates of the drills and individual staff performance statistics, should be kept on file;
3. Keeping the staff abreast of all updated information when it becomes available;
4. Evaluation and redesign (if appropriate) of all existing programs.

After an emergency plan of action has been developed, the staff has been trained and affiliates have been educated, a written policy of emergency procedures for the sailing program should be submitted to the governing body. This policy should be made part of the permanent record during an open meeting.
 
Developing emergency procedures should rank high on the priority list of all persons involved in the proper management of any educational or recreational facility. A serious emergency may never occur; however, if one does, being prepared may mean the difference between life and death, and also between a satisfied program participant or member and a lawsuit.

EMERGENCY PROCEDURES
The management of sailing facilities and programs is becoming increasingly complicated, especially in the area of protecting the welfare of participants and their families. Awareness of correct safety and emergency methodologies has broadened with increasing interest in water safety and first aid programs. The knowledgeable public has the right to expect professional
action to be taken when and where its welfare is threatened.

An emergency can be broadly defined as “a sudden, generally unexpected occurrence or set of circumstances demanding immediate action.” Emergency situations may take many different forms, depending on the location and circumstances in which they occur. Emergencies may be classified according to their degree of danger:

Life Threatening Emergencies and Non-Life Threatening Emergencies.
Life threatening situations often require rapid removal from the initial accident scene, the administration of immediate, effective first aid and rapid notification of the EMS (Emergency Medical Services) system to provide transport to more definitive hospital care.
Examples of life threatening emergencies would include but not be limited to:
* Stoppage of breathing
* Severe bleeding -
* Poisoning
* Heart attack
* Spinal injury
* Heat stroke
* Fire
* Epileptic seizure

Non-life threatening emergencies involve a situation whereby the action of one or more staff members is required but the danger to the students or participants is considered minimal. There are two levels of non-life threatening emergencies:
1) Major – which would include situations such as broken bones, or a number of boats all capsized at once during a squall; and
2) Minor – includes situations such as sunburn or abrasions.
A non-life threatening emergency may become life threatening if not handled properly. Although the immediate danger to the victim is minimal, the instructor still has the responsibility ofproviding the best care possible.

TYPES OF INJURIES IN A SAILING PROGRAM
As sailing is a water activity, aquatic accidents involving immersion and exposure would be expected to involve the majority of injuries and problems sustained. This is not necessarily true. Sailing involves normal land based activities, as well. Therefore, the potential for injury of any type exists. Injuries and accidents range from the relative minor cut and scrape to the catastrophic
potential fatality. For example:
* Bleeding wounds resulting from falls; lacerations and abrasions from poorly maintained or defective equipment; incisions from the improper use of a knife; coming in contact with a sharp object, metal edge or broken glass. Any of these can occur when going barefoot.
* Contusions – bruises from bumping into or being bumped by moving boats or boat parts
* Fractures – fingers caught between two boats or between the boat and limbs becoming entangled in rigging or hiking straps when a boat capsizes
* Burns – mainly first or second degree from overexposure to the sun
* Head injuries – struck by the boom or a falling mast
* Neck and back injuries – falling on land or in the water in a way so as to cause injury to the spine or spinal cord
* Electrocution – from overhead wires; failure to clear the water during an electrical storm
* Hypothermia – a drop in core body temperature below 98.6 degrees F as a result of improper clothing; falling into the water when unprepared or any number of causes that results in a person becoming cold and chilled
* Sunstroke or heatstroke – a rise in core body temperature characterized by extremely high temperature and disturbance of the sweating mechanism. The extent of overheating is determined by the relation of the surrounding environment to the kind and amount of clothing worn, the amount of humidity in the air, the amount of air circulating (wind), and the person’s own body metabolism
* Drowning – a type of asphyxia related to either aspiration of fluids or obstruction of the airway caused by spasm of the larynx while in the water
* Shock – a condition resulting from a depressed state of many vital body functions. The degree of shock is increased by abnormal changes in body temperature, by poor resistance of the victim to stress, by pain, by rough handling and by delay in treatment

FIRST AID KITS AND EQUIPMENT

Every sailing facility should have proper first aid equipment on site for use by properly trained members of the staff. Confer with local authorities, emergency or safety organizations and the American Red Cross for guidance in assembling the appropriate equipment and apparatus for your program.
 
Every facility should have a complete inventory of first aid supplies. Such an inventory is for use at the facility as well as serving as the supply source for stocking safety boats and individual first aid kits. Supplies stored will vary from area to area, depending on local environment and the types of accidents and injuries that occur most frequently.

First Aid Room
A readily accessible room or designated area equipped for emergency care should be known to all and be well identified. The doors and hallways leading to it should be wide enough for backboards, stretchers or wheelchairs. The room should be private and out of the main flow of traffic and should have access from several different directions. Ventilation and lighting should be adequate for examination and treatment purposes.

Equipment and Supplies
Equipment and supplies for a First Aid Room comprise three categories.

1. Work Area
a) Cot with blankets
b) Desk and chair
c) Sink with running water
d) Counter top space and storage space
e) Refrigerator – for storage of ice and plastic bags
f) Clock
g) Telephone and radio communications
h) Paper towels and cups

2. First Aid Supplies
a) 24 – unit First Aid kit
b) First Aid book
c) Cervical collars: child sizes and S-M-L for neck immobilization
d) Backboard and straps
e) Splints of various sizes and ties. Could include:
board splints, ladder splints, cardboard splints, air splints or any other which intent and
purpose is to immobilize an area of suspected fracture
f) Oxygen equipment
g) Flashlight
h) Liquid soap dispenser
i) Sunblock
j) Sandbags (2 at least) to prevent side-to-side movement of the head when backboarding
k) Thermometer – normal as well as hypothermia

3. Record Keeping
a) Accident/incident forms
b) List of emergency phone numbers and procedures
c) Paper, pens, photocopier
First Aid Equipment for Rescue Boats
1. Loud hailer
2. Tow lines
3. First Aid kit
4. Splints and ties
5. Cervical collars for neck immobilization
6. Backboard and straps (6, 6 feet long)
7. Blankets
8. Sandbags for neck immobilization

In-Service Training
Instructors and all employees must be trained to dispense first aid in a quick and efficient manner, specializing in situations specific to the marine environment. For this reason, program administrators must emphasize sound first aid training and maintain a continuing liaison with medical experts to remain abreast of new developments and new, more effective first aid techniques.

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