Everyone who rides a horse or organises an event knows how unpredictable and dangerous equestrianism is. Every year both at home or when competing, riders are seriously injured or even killed. It is an organiser's nightmare.

Most equestrian events these days have some form of first aid or paramedic cover, but what is the difference between different types of cover, and which do you require?

Traditionally, event organisers had little choice in choosing cover, often booking voluntary organisations or the local ambulance service. So what levels are available?

A first aider is usually a person who has completed a four-day approved training course which covers basic life support and coping with accidents until the ambulance service arrives. It is the type of course that is taught for the work place, schools and offered to the general public through approved training pro-viders.

Unless they have received extra training they do not usually carry any additional equipment other than a basic first aid kit.

An important note to be considered by anyone who is thinking of organising an event with first aid cover is that if someone volunteers to provide first aid cover either paid or unpaid, they are not covered by the Samaritan act, which means they are liable for any medical malpractice. This could prove to be very costly.

An emergency medical technician, who usually accompanies a paramedic, is a highly-trained person who can perform and manage trauma and medical problems to a higher level than general first aid, and is used to dealing with medical equipment.

A paramedic can do all of the above as well as administer life-saving drugs and perform invasive therapy such as running intravenous lines, and has a wide range of diagnostic skills which are vital in the assessment of a trauma case. All paramedics are used to dealing with both medical and emergency cases on a daily basis.

There have been massive improvements and ad-vances in the way paramedics are trained in recent years, and there is now a state register of paramedics which anyone can access and check if their paramedic is genuine. This is very important, as anyone not on the list is not a paramedic and can not legally carry the paramedic title. There are no exceptions to this rule. The web site for this free service is www.hpc-org.uk.

Paramedics have to provide evidence of continual clinical practice and prove their competencies annually to remain state registered.

The obvious benefit in having paramedic cover is having on-scene advanced life support. The first few minutes following an accident are vital for the patient's chance of survival - the more skilled and equipped the staff providing the treatment are, the better the outcome is.

Another less obvious benefit is the fact paramedics can provide a professional handover to the ambulance service or hospital, which ensures ongoing expert treatment. This includes emergency air ambulances in the more serious of cases.

First Aid Medical, of which I am director, has been providing cover for equestrian events for more than four years and we have a comprehensive list of equipment in all its vehicles, including defibrillators in the case of heart failure, oxygen and entonox therapy, spinal immobilisation equipment, advanced airway management, drugs for use in trauma and cardiac arrest and patient monitoring systems.

At most events covered, thankfully paramedics are rarely used to their full potential, but in the last four years First Aid Medical has had to deal with a number of potentially life-threatening incidents.

The communications provided by paramedics are important, they have direct contact with the ambulance service, usually via radio as mobile phone signals can be unreliable, although mobile are used too.

The organisers of any event should always make sure they can call the paramedic directly. It is also useful if you have a grid reference for your location, which can be passed on if required.

A final consideration should be the ambulance itself. Ideally it should be four wheel drive to access and negotiate difficult and often wet conditions.

It is highly unusual for a paramedic to transport the patient to hospital but they may be required to move the patient to a collection point to meet an NHS crew.

Remember, the first few minutes are vital in the chain of survival, so book the best you can. Its best to think of medical cover as an insurance policy - seldom used, but a must-have service

Published: 26/11/2004