(A/N: I don't own Paw Patrol, enjoy!)
Chapter 3: A Basic Medical Training
At 8am, the pups all lined up outside.
"Ready for training Ryder Sir" Chase called out.
"Thanks for being ready on time, pups," Ryder said "Today we have some special training that Marshall will be giving. This morning all of you are going to learn the basic skills required to provide lifesaving aid to a patient in distress, be it human or animal. Then, this afternoon, some of you will get an introductory look at how to be EMT's like Marshall."
The pups all cheered in anticipation.
"Ok pups, first thing in any medical emergency is to make sure that the scene is safe for you to assist the patient" said Marshall as he took his place in front of the rest of the pups, "it doesn't do anyone any good if you rush into a situation and become an additional patient. If the scene isn't safe, you need to work with the rest of team to either make it safe or safety extract the patient from the scene." The pups all nodded along. "Alright, I need one volunteer"
"Me, me, ME!" yipped Everest excitedly.
"Ok, Everest, come lay down here" Marshall said.
"Ok!" Everest yipped, barely able to contain her excitment.
"Now the first thing about moving a patient is to keep it as smooth as possible because jerky movements can cause more injuries" instructed Marshall. "Second, try and keep keep the patient's spine straight while being move. If you can get the patient onto a stretcher or backboard, that is preferable."
"Will my suwfboard work, dude?" asked Zuma.
"Absolutely" replied Marshall "But absent a stretcher or other board, you'll likely have to drag the patient to safety. Try to drag them in a straight line if possible. On humans you want to grab onto their shoulders. If they have a backpack with undamaged straps, that works even better as it is more centered. For animals, the scruff of the neck is usually the best place. Now watch as I demonstrate."
Marshall leaned down toward Everest but caught a whiff of something enticing. "What is that smell?" Marshall whispered to Everest.
"Surprise Snowfall" she whispered back.
"Oh, wearing it for anyone in particular?" Marshall asked curiously.
"Maybe" Everest answered coyly. "Do you like it?"
"It is intoxicating" Marshall replied as he gently grabbed her by the scruff of her neck.
"Don't drop me" Everest giggled at him.
"Don't worry, I won't" Marshall confidently replied as he slowly demonstrated proper dragging technique. Once he had dragged Everest about ten feet he stopped. "Alright, pair off and practice a few times.
The pups all paired off, Chase with Skye, Rubble with Tracker and Rocky with Zuma.
"You sure you want to practice with me Skye?" Chase asked her "I'm the largest dog and you are the smallest, wouldn't you rather practice with Zuma or Tracker?"
"They might be lighter" Skye replied with a giggle "but I know it is important for me to be able to move larger dogs by myself so I may as well practice with my big, buff and blushing boyfriend." Chase tried to hide his blush as he obediently laid down.
After everyone had practiced pulling a few times, Marshall barked for their attention. "The next technique I'm going to demonstrate is the buddy carry. This is more situationally useful for when the ground is very rocky and you can fully lift the patient. The key is to bring the patient smoothly onto your back, with their weight evenly spread so you can carefully walk out of the danger area." Marshall demonstrated by laying Everest on her side, kneeling down next to her, and then using his fore paws he smoothly rolled her onto his back as he stood up. "Your heart is beating pretty fast, are you ok?" Marshall whispered to Everest as he slowly started walking with her.
"I'm perfectly fine" she whispered back as she gave a slight wiggle to comfortable situate herself.
Marshall grinned to himself as he walked about ten feet with her before carefully laying her back down. "Now, this technique does require you be the roughly the same size or bigger than the patient, so Skye pair up with Tracker for this one."
After a couple carries, Marshall continued on to the next part of the lesson. "Now that the patient is in a safe location, we can treat them" Marshall transitioned.
"Aww, why do the injured get all the treats?" whined Rubble.
"Actually Rubble, you don't want to give anything to an injured patient as it can cause issues later. The only thing you should give is water if they are dehydrated" Marshall laughed in response. "That being said, the first thing to look for are life threatening injuries, usually anything impacting the patient's ability to breathe or their blood circulating, including major bleeding. Major bleeding should usually be addressed first because if you start CPR before major bleeding is contained, you could cause the patient to bleed out faster. The way to stop bleeding is to apply pressure, either directly or with a tourniquet."
"What's a tourniquet?" asked Skye, cocking her head to the side.
"Good question" replied Marshall, "a tourniquet is basically a very tight bandage around a limb that cuts off blood flow to that limb. It should only be used when direct pressure cannot contain the bleeding, like if a limb has been amputated or a major artery has been cut. Ryder, can you please bring over the kit?"
Ryder brought over a little hose and a clamp attached to a pump motor and attached it to Everest's fore limb.
"Ok" Marshall continued "life threatening bleeding with normally be in rhythm with their heart beat, like so." Marshall signaled Ryder who started the machine which started squirting out a blood-red fluid in what looked like the rhythm of a heartbeat. The other pups all immediately gasped and promptly fainted.
"Looks like we'll need the smelling salts" laughed Ryder as he turned the machine off.
"That we will" replied Marshall as he walked around, waving the smelling salts under each pup's nose until they slowly woke up. Once everyone was awake again, albeit all of them white around the gills to some degree, Marshall continued. "Now that you've seen, and fainted from, the sight of fake blood, here is how you stop it." He carefully placed a tourniquet loosely around Everest's forelimb, right over the clamp that held the fake blood vessel in place. "Now loose like this, a tourniquet doesn't do much, but as I tighten it…" Marshall signaled Ryder again and the machine started pumping again "the tourniquet stops the blood from flowing." Marshall tightened the tourniquet down until the blood stopped. All the pups were amazed, if still a bit queasy from watching the demonstration; there was a large puddle of fake blood on the ground next to Everest. "The other two things you have to remember with a tourniquet are to write down the time applied and to not take it off. The time is so that the doctor knows how long the tourniquet has been on. You never take a tourniquet off because the bleeding will be much harder to control and it should only be done in a hospital environment where doctors and nurses can replenish the blood being lost and have more tools available to control the bleeding."
"Now that bleeding is controlled, we can move onto CPR to restore circulation to the body and breathing."
(A/N: Marshall is a certified CPR instructor and goes into more detail with the pups so that they are able to be certified. I, the author, am not a certified instructor and reading this story does not replace you going to a class and getting certified. If you are interested in becoming CPR certified, find an American Red Cross or American Heart Association class near you! You never know when bring prepared can save someone else's life!)
"The six links in the adult out-of-hospital survival chain of survival are 1) recognition of a cardiac event and notification of emergency medical response teams, 2) Early CPR with an emphasis on chest compressions, 3) Rapid defibrillation, 4) Advanced resuscitation by EMS, 5) Post-cardiac arrest care, and 6) recovery. We will be focusing on the first three as that is our role. Right now, only my truck has a defibrillator but that will change soon once some of you get EMT certified.
"Once we identify a cardiac event, we will let Ryder know and he will pass the necessary information on to ensure timely response. While Ryder is notifying others that we need assistance, whoever is on scene will perform CPR. CPR consists of chest compressions and rescue breathing at a ratio of 30 compressions to 2 rescue breaths. Compressions should be performed at a rate of 100-120 per minute and to a depth of at least 2 inches on an adult human. Compressions deeper than 2.4 inches should be avoided and depth will vary for children and other animals depending on their size. The best way to maintain 100-120 compressions per minute is to use the beat from the song 'Staying alive.' Rescue breaths are given by tilting the head back, making sure the airway is free of obstructions and then breathing directly into the patient's mouth. The best rescue breaths maximize the amount that exhaled air goes into the patient by filling your mouth with air that you haven't breathed in and using your exhale to push that air in. You should see the patient's chest rise and fall with each rescue breath. You continue until someone else takes over, or you cannot continue any more from exhaustion."
Ryder and Marshall then broke out the training dummies and spent the next few hours practicing with all the other pups. Marshall also showed them how to use his Automated External Defibrillator so that they could all use it safely in case of an emergency. Before they knew it, it was almost time to break for lunch.
Marshall called all the pups back in around him. "Ok, the last thing we are going to go over is the Heimlich maneuver. This is used when a patient is chocking or otherwise has a blocked airway but is still conscious and has a pulse." Pulling Everest up to stand on her two rear paws, Marshall stood behind her with one of his rear paws in front of her paws for balance. "Now, you take your paw and make a fist and place it right above the person's or pup's navel and put your other paw on top, grasping it." Marshall carefully placed his paws on Everest who felt the heat rising in her from this position. Marshall felt her heart rate and breathing increase so he interjected "If your patient starts to freak out, remind them that you are here to help them and that it will be ok." Marshall then spoke with a soft but firm tone, loud enough that everyone could hear him but to Everest, it sounded like he was whispering straight into her soul. "It will be ok, my name is Marshall and I am an EMT, I am here to help you. Your airway is blocked and I need to clear it. Stay calm and I won't let go until you are safe." Everest practically melted against Marshall, feeling completely safe in his grasp.
"Ok, now that the patient is calm, you perform the maneuver by pressing into the abdomen with a quick upward thrust as if trying to lift the person up like so." Marshall performed a single upward thrust on Everest and she immediately left the upward pressure and gagged. "Now you repeat this motion six to ten times until the blockage is dislodged."
"I'm good, I don't need any more, I can breathe fine" Everest panted, slightly alarmed that Marshall might be about to demonstrate nine more times. She did not want to throw up right before lunch.
Marshall laughed before continuing "You'll know your patient's airway is clear and the obstruction dislodged when they start to cough or they tell you as Everest so perfectly demonstrated." The pups all laughed.
"Now" Marshall continued "if the object still does not become dislodged, you can bend the patient over at their waist until their chest is parallel to the ground, supporting their chest on your limb…" Marshall flipped Everest over almost effortlessly, making her slightly light headed "and deliver back blows between the shoulder blades with the heel of your paw." Marshall then demonstrated a single back blow on Everest who gagged even harder but managed to not throw up.
"I can breathe, I'm fine!" Everest yelped while the other pups laughed.
Marshall laughed as well before continuing "alternate between back blows and the Heimlich maneuver at a ratio of 5 each until the object is dislodged or the patient loses consciousness. If the latter happens, immediately start CPR."
Marshall finally released Everest who wobbled a little as she stood before getting a devilish glint in her eye. "Oh, thank you Marshall, you saved me!" Everest said with enough theatrics to make a stage performer blush. "How can I ever thank you for saving my life, you handsome EMT you!" as she pressed her muzzle up under Marshall's chin and slid her paws around his neck.
Marshall blushed as he responded "It was my pleasure ma'am, I'm happy to have been of assistance to you.
"Oh please, let me thank you properly for saving me" swooned Everest as she looked up at Marshall with loving eyes.
Marshalls eyes got as wide as dinner plates. "Well, I will conclude today's training with a lesson on what to do after you save someone's life. It is natural for the patient to have a lot of pent of emotion and relief once you save them and it can manifest itself in different ways like you see before you" Marshall gestured to Everest who was trying to keep her paws wrapped around his neck, alternating between an evil grin and loving eyes. "And I recommend the following response:" Marshall turned to look straight into Everest's eyes "I'm glad to have been able to save you ma'am" as he carefully but firmly removed her paws from his neck and slid them down his body while turning as red as his ambulance "but if you'll please excuse me, I have other patients to save…" as his paws reached the magic point where he was free for a split second "…and I really must be going, bye!" Marshall shot out of Everests grip like a rocket as all the other pups fell on the ground laughing hysterically as Everest gasped before falling flat on her stomach on a carefully placed emergency blanket that cushioned her fall perfectly.
She shook herself briefly, wondering how and when Marshall had managed to place that blanket there before jumping up and tearing off after him. "You won't get away from me my beautiful savior you!" She barked as she chased him around the lookout.
"And this why…" Marshall panted as he passed the laughing pups "…Cardio is…" another lap "…so important!" He finished as he managed to stay just out of Everest's reach for another lap.
"I think he's had to do this before" chortled Rocky as Marshall and Everest passed by again with Everest yelling for him to come back here and let her love him.
"More than you know, bro" Chase laughed as Marshall and Everest made their sixth lap past the pups.
Presently, they only saw Everest making laps around the lookout.
"Where did he go?" exclaimed Zuma.
Everest stopped and looked around confused. "He was right in front of me, where could he be?"
Rocky poked his head into Marshall's pup-house "Not here" he reported.
The pups took 5 minutes to check their pup houses and all the bushes but they couldn't find Marshall, it was as if he vanished into thin air. Then Rubble's tummy growled followed by all the other tummies.
"Sounds like we need to eat lunch before we search more" laughed Chase and the pups all headed inside.
Everest walked in next to Skye and whispered into her ear. "And I was so close, I almost had him."
Skye laughed "That was the funniest thing I've seen in a long time. You were both running so hard around and around, I almost got dizzy watching you!"
Everest laughed with her best friend, "Yeah, I'll have to figure out how he…" Everest stopped mid-sentence as all the pups walked into the kitchen to find Marshall calmly finishing making sandwiches for lunch. "…made us lunch while we were looking for you?!"
"Well, it's quite simple really, I already know what each of you love to eat so I just threw the ingredients together and…Hey!" Marshall yelped as Everest tackled him to the floor and pinned him down.
"I have to know how you escaped me if it's the last thing you say!" Everest barked at him.
"EMT Secret missy" Marshall teased back "and I'll never tell ah oh no, eh ah stop ah that ah!"
Marshall started squirming, wiggling and laughing uncontrollably as Everest tickled him.
"Tell me!" Everest howled at Marshall while the other pups collapsed on the floor in laugher again.
"Never!" Marshall managed to get out between laughs "Liver ah ek sandwich oh ep end ah!"
Everest leaped off Marshall to her lunch and took a deep sniff. "You might be free for the moment Marshall, but I will find out eventually" Everest said with an evil grin before diving into her lunch.
The other pups finally were able to pick themselves up off the floor as Chase help Marshall up who was still trying to slow down his breathing.
"You alright bro?" Chase asked with mirth in his voice.
"Yeah, just give me a minute" breathed Marshall.
Chase leaned in and whispered "you still have to make it the rest of the day."
"Don't I know it" Marshall whispered back.
After lunch, the pups all re-assembled outside to continue training.
"You've all put in a lot of hard work today pups" Ryder said "but some of you are done for the day. Chase, Rocky, Rubble, Skye, you are free here in a minute. Everest, Zuma and Tracker, this afternoon Marshall is going to give you a crash course in all his EMT gear. This isn't enough to certify you but we'll be working on that over the next few weeks. This is just so that in case anything comes up in the next few months, that you all can handle it."
"What?" asked all the pups except Chase and Marshall.
"Where is Marshall going?" asked Everest.
"I've decided that we need to be more medically capable" Ryder replied "and Marshall has also wanted to get more training so for the next three months, he will be in school to become the first Paramedic pup!"
"Wow" murmured the other pups.
"First in the world, the one and only?" asked Rubble.
"That's right" replied Marshall "this will help us keep more people alive and Adventure Bay safe."
"But Mawshall, I though you aweady were a pawamedic?" asked Zuma.
"Not quite" Marshall replied, "I'm an Emergency Medical Technician (EMT) which is good for most medical emergencies but there have been times where being a paramedic would have been very helpful."
"Does it really take that long?" asked Rocky, though a certain other pup was wondering the same thing.
"Yes" replied Marshall "especially since I'll be the first paramedic pup and they will be integrating animal care into the course as well; we want to make sure I'm as ready for any animal emergency as well as human emergency.
"Ok pups" Ryder interjected "Time is ticking and Marshall leaves first thing in the morning. We only have a few hours for him to teach Tracker, Zuma and Everest how to use his gear in an emergency so we best get to it."
Marshall led Zuma, Everest and Tracker over to his ambulance to start training while the other pups went inside for a Pup-Pup-Boogie tournament.