2b-Chirurgeon-art - 6/30/02

"So you want to be a Chirurgeon" by Philippa Ferraria.

NOTE: See also the files: SCA-PR-msg, evnt-stewards-msg, waterbearing-msg, insect-prtctn-msg, lighning-msg, ticks-art, privvies-msg, p-medicine-msg.

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NOTICE -

This article was submitted to me by the author for inclusion in this set 
of files, called Stefan's Florilegium. 

These files are available on the Internet at:
http://www.florilegium.org

Copyright to the contents of this file remains with the author.

While the author will likely give permission for this work to be 
reprinted in SCA type publications, please check with the author first
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                               Thank you,
                                    Mark S. Harris
                                    AKA:  Stefan li Rous
                                         stefan@florilegium.org
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So you want to be a Chirurgeon
by Philippa Ferraria.

So you want to be a Chirurgeon, or possibly you just want to know more about us. I first served my Apprenticeship at Pennsic XXV. I started out just to help where I could, as a Scribe, and by the end of War I was hooked- I had gotten my certs in order, joined as an Apprentice, and a few months later was Warranted.

So, what does all this mean?

I suppose that the best thing to do, is tell you what a Chirurgeon is.

A Chirurgeon is a member of a Guild in the SCA, devoted to providing First Aid to the people at SCA events. Membership in the Chirurgeonate requires: SCA membership, current Red Cross Basic First Aid or equivalent, or better, certification, and current CPR certification. After you serve your Apprenticeship, you will become a Chirurgeon, Warranted under the Kingdom Chirurgeon of your home Kingdom. At that point, you are called a Journeyman and allowed to be Chirurgeon in Charge at events, or to treat patients without supervision.

To become a Chirurgeon:

First, you must present your current certifications and membership to your Kingdom Chirurgeon. S/he will then tell you what the requirements are for your Apprenticeship in that Kingdom (it varies), and once you have fulfilled those requirements, you will be Warranted in your Kingdom- this Warrant will be honored in any other Kingdom you may play in, but if you move, you need to be Warranted by your Kingdom Chirurgeon in your new Kingdom. You will not however, be required to serve another Apprenticeship.

Apprenticeship:

All would be Chirurgeons serve an Apprenticeship. Whether your certifications are of a basic First Aider, or an MD, you will serve as an Apprentice first. The reason is so that you will learn the specific protocols and ways of doing things within the SCA- you should learn, for example, how to deal with armor and other garb, when to help, and when to walk away, and what to do while you're there. If you have little experience treating injuries, or don't know the proper way to wear and remove gloves, we'll teach you.

Most Apprenticeships require you to serve a set number of events or shifts under the supervision of a Warranted Chirurgeon. If they feel you're successful, and do well, they'll send in a report to the Kingdom Chirurgeon saying as much. If they feel you need more training, they'll say that also. It's much like becoming a Marshall in any of the weapons fields.

Understand this- whatever your certs, BFA, EMT, RN, MD, you are not a Chirurgeon until you complete this process, any more than a Chirurgeon becomes an MD by becoming Warranted. While the skills overlap, each is a different thing- I served my Apprenticeship with another Apprentice who was an MD, and I've had Apprentices who were MDs serve their Apprenticeship under my supervision, and I'd like to think we both learned from the experience ;-)

Warranted Chirurgeons:

OK, you've got your Warrant- now what? Well, for one thing, in many Kingdoms you are technically an Officer of the Court. It's a paperwork thing- you may well be one of your Shire's Officers, if you're in a small shire. You may take another office as well, but only Warranted Chirurgeons can be their group's Chirurgeon, as with Marshalls, I believe.

If you've been properly trained, you now know how to fill out your paperwork, and where to send it. At this point, you may go to events and volunteer for a shift, or set up with the other Chirurgeons. Generally, you enjoy yourself as you would at any other event, other than not drinking alcohol before or during your on duty period, and wait for a call. Usually it seems to work out that you'll be having a quiet, uneventful day, and suddenly everyone at the event will bring you their stubbed toe, broken blister, armor bite, poison ivy and sunburn at the same time ;-) You should have a kit with you, including band-aids, sun burn cream, etc.

Your kit:

Depending on where you are and the policies of your area, either they will have a kit for you (it happens occasionally) or you will have to buy and stock your own kit. There are a number of things you may want in your kit, but keep in mind, that _YOU_MAY_NOT_GIVE_OUT_MEDICATIONS_, even over the counter things like aspirin. There are ways to make it available without giving it out, and your Warranted Chirurgeon will explain them to you, but when in doubt,  _YOU_MAY_NOT_GIVE_OUT_MEDICATIONS_,

Now, while it is tempting to carry an entire hospital in your bag, it's not very practical- for one thing, you may need to carry the blamed thing, and a 200 lb pack is not a joy. If you're EMT trained and certed, there are certain little toys you might like to have handy. Most people who have a lot of toys have two bags- one for bulky, heavy stuff which is less used, the other that holds most things they're likely to need at an event. Experience will tell you what you want where.

Along with the usual bandaids, first aid cream, bandages, dressings, tape and whatever else, there are a few things I like to include. First and foremost is gloves. _NEVER treat a patient without using gloves_
_NEVER treat a patient without using gloves_
_NEVER treat a patient without using gloves_
_NEVER treat a patient without using gloves_

It bears repeating. DON'T forget. Need I add, fresh gloves for each patient?

My preference is to avoid using latex gloves because many people are allergic to them, and if you don't have latex gloves, you can't forget to ask if they're allergic, and maybe increase the problem. The non-latex cost a little more, but it's worth it to me to have one more thing not to think about.

Another good thing to have are individually wrapped sanitary napkins, the pads, not the tampons. Not only is it nice to have them for ladies who unexpectedly get caught with their periods, but they're great pressure bandages in a pinch. I keep paint stir sticks in my kit for splints- they're small, light, and cheap, and strong enough to immobilize most injuries. Ace bandages in various sizes- you can frequently find them on sale, cheap. Sports tape and the stocking material that goes under it, if you know how to use it. A flashlight, with real, live, batteries in it. Tweezers, and bandage scissors. NEVER use a knife on someone's armor or clothing- it's too easy to slip and cut them. There are two types- the small ones, and the big, heavy ones- have both. Duct tape- fighters will love you for it, and it's handy to use to tape ice bags to their armor, if they get a thump that needs iced, not to mention for taping their helmets to backboards or shields if necessary. I usually carry one or two of the chemical cold packs, but I rarely use them- instead, I carry a bunch of ziplock sandwich bags, the heavy freezer type, and fill them with ice, at need. The chem packs are there if I can't get to ice in a hurry. As far as bandaids, I strictly carry the ones with cartoon characers, because the expression on a big, bad fighter's face, as he wanders off with his Tweety Bird bandaid is priceless ;-) Baby wipes and the waterless hand sterilizer. Yes, you'll likely be able to wash your hands on site, but I like to use these between patients, before I glove- you can never be too clean. I usually have a supply of condoms, but in a "Free" basket, slightly out of my sight, close enough I can keep children out of them, but not where anybody who needs a couple has to look me in the eye. There may be other things you'll want- every Chirurgeon has their own preferences, but that should cover the basics, without loading you down.

Treating your patients:

First, Do No Harm.

The first thing you need, before anything else, no matter what is going on, is an attitude of calm. Yes, you may have to move fast, but if you're upset and showing it, all you're going to do is make the patient upset, so if things are bad enough that you're starting to freak out, go away and call 911. Whatever you do, don't add to the problem.

Your actual treatment of the patient should have been taught to you in your certification classes, and as you work with the rest of us, we'll teach you odd little tricks and such that we've picked up to further your education. What I intend to cover here is dealing with specificly SCA patients.

As a Chirurgeon, you're usually the first person with a clue on the scene. Your job is to find out what is happening, and, if necessary, to call 911. Most minor injuries you can treat yourself- a bandaid, an ice bag, or sometimes just a calm voice until the patient feels a bit better. You're there to control the scene and your ONLY concern is the person who needs your help. With that in mind, if you think people need to be moved away, you can ask a calm person to get the crowd to back off, or go dial 911, or get a cup of water, or whatever else you need, but the way to do it is not to say "Will someone..." but rather look someone dead in the eyes and say "Will YOU please....." Once you've assesed the scene, and know what is needed, then it's your job to either do it, or see that it's done, and to stay with the patient until either they're OK and capable of going off about their business, or until you release them to someone of higher certs- an ER physician, for example, or the ambulance personnel.

A few SCA specifics:

ALWAYS introduce yourself, and ask permission to help.
ALWAYS be polite, to the patient, to bystanders, to Marshalls, or whoever else. You're there to help, not to anger people or play dominance games.
NEVER use a knife or dagger on a patient or hir clothing or armor.
NEVER quickly open a tight bodice- you could drop their Blood Pressure in a hurry, and put them into shock.
NEVER cut armor unless the patient says it's OK, and tells you what to cut. IF you suspect a neck injury, immobilize them armor and all, as long as they can breathe. Removing a helm could seriously injure the neck, and the helm will make it easier to keep them immobile on the way to the hospital.
NEVER let them hand you a nasty, dirty, slimy awful plastic athletic cup. If they're mobile enough to remove it, they're mobile enough to drop it on the ground ;-P

IF they refuse treatment, don't insist. If you think they're in need of medical care, call 911 and let them argue with the ambulance crew- you don't need to argue with them. If they're bad enough off that they pass out, they're yours anyway. Do however, stand by until the situation is resolved.

READ AND UNDERSTAND the Fighter's Bill of Rights:

http://www.chirurgeon.org/point_mar_97.html

And, above all, don't jump at them and be handling them without their permission. Give them a chance to realize who you are, and what you intend to do- you usually need a space of time to assess the situation anyway.

And NEVER, Never, Nevernevernever EVER talk about a patient by name or any other identifier to anyone outside of immediate need to know- medical personnel, or your assisting Chirurgeon, maybe, in the course of resolving the situation, but beyond that, your patient is entitled to hir privacy.

Now, among ourselves, we often discuss patients we've treated and situations we've dealt with, but they are described by something which doesn't identify the person- the asthma attack, for example, or the oil burn, or the broken leg, but naver as Lady Whozis, or Sir Whatzit, or even Joe.

And, any time you feel you're in over your head, dial 911.

A note for those of you with higher certs:

You may be trained and licensed to perform procedures beyond basic First Aid. That's fine. If you then treat the patient with his or her permission, remove your baldric- you are not now functioning as a Chirurgeon. Chirurgeons provide basic First Aid ONLY!!!!! And, yes, I understand that circumstances may not allow you to physically remove your baldric- just understand- you're working on your personal certs and liability.

The Chirurgeon's Guild itself:

We're a great group of people. When you become a Chirurgeon, you'll be working with the nicest group of people you can imagine. We're at all certification levels, with all different types of training in those levels, and we all want to make things pleasant for everyone, even that idiot who KNEW better than to try to balance a sharpened greatsword on his nose ;-) You'll find people here whose favorite thing to do is to help others, and very little competition or backbiting.

We are organized in a similar manner to Medieval Guilds, with three levels- Apprentice, Journeyman, and Master.

Apprentice:

As an Apprentice, you're learning the ropes and the basics of what you need to know about being an SCA Chirurgeon. You aren't Warranted yet, and you'll work for a while with a Journeyman or Master, so you know what's expected of you. You may wear a Chirurgeon symbol as a favor, or in some Kingdoms, so I hear, on a red baldric with no stripes.

Journeyman:

Here, you're considered to be competent. You aren't expected to know everything about anything, but you are expected to be able to handle situations on your own- including knowing when to call for help. You are not inferior to a Master- a Master can't overrule you on a patient. But, if anyone sees you doing something totally stupid, like applying a tourniquet at the neck, you will be stopped. Otherwise, you'll be allowed to proceed, and the matter will be quietly discussed with you, and perhaps suggestions made as to how to do better. You are allowed to wear a red baldric with white stripes on the edge with the Chirurgeon's patch on it. In some Kingdoms, I understand that a plain red baldric with the patch is the symbol.

Master:

A Master is just an experienced Journeyman who has been given an Honorary title because s/he's convinced the other Masters that s/he really knows hir stuff. Masters have no right to override a Journeyman or take their patient away from them, but they're usually incredible resources available to help you with a tough situation. The gold stripe is to let you know they're there to help you- most people other than Chirurgeons don't know what it means. Their baldric is red with gold stripes on the edge and the Chirurgeon's patch.

When you're on-duty as a Chirurgeon, you wear your baldric- this helps people spot you in a hurry. If you're off-duty, but available to help in a pinch, or coming off or onto a shift, most Chirurgeons wear their baldric in their belt as a favor, and cause it to vanish entirely when they're totally off duty. Unfortuately, you'll find that once you're known as a Chirurgeon, you're never totally off duty- they'll come and find you at need. I try to have an absolute rule, that the last patient of the day preceeds the first drink of the day, particularly at Pennsic. Unfortunately, it seems that no sooner have I sat down and had my first shot of single malt Scotch, someone needs me. It's enough to make me take up bourbon, instead.....

This is not the official stance, but rather my experience as a Chirurgeon. For the Official explanation of what a Chirurgeon is and does, go to:

http://www.chirurgeon.org/

There's lots of good information there, including files to look at, and specific details, as well as, I believe, a current List of Kingdom Chirurgeons.

Philippa Ferraria,
Journeyman Chirurgeon of East Kingdom,
formerly of the Middle Kingdom.

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Copyright 2002 by Philippa Alderton, <phlip@99main.com>. Permission is granted for republication in SCA-related publications,  provided the author is credited and receives a copy.

If this article is reprinted in a publication, I would appreciate a notice in the publication that you found this article in the Florilegium. I would also appreciate an email to myself, so that I can track which articles are being reprinted. Thanks. -Stefan.

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