First Aid Volunteer Instructions

Firefly First Aid

Assist fellow participants in removing their own splinters, finding the first aid supplies, and helping figure out if they need to go to the EMT tent.

We are:

1. always sober for our entire shift
2. sober for an adequate amount of hours before our shift
3. licensed professional volunteers (MD, DO, PA, NP, RN, Paramedic, EMT, Armed Forces Medic)
4. unlicensed volunteers (including CNAs, those with Wilderness Medicine First Responders training and experience, First Aid and CPR training, etc...)

The Core Leads for Firefly First Aid in 2025 are Lia Rudolph, Julie Cannon, and Kalmen Barkin

Go-Bags will be in the First Aid Tent behind Ranger HQ

This year we will have bags with basic supplies to use on your shift. Take one at the start of your shift and restock it at the end for the next volunteer.

Staffing- Schedules will be posted at the First Aid tent

Each 8 hour shift has 2-3 First Aid volunteers on duty.  The volunteers are a team and  respond together for any significant call.  As long as you can wake up by a call on the radio,  it is fine to sleep on the overnight shifts.

Unlicensed volunteers are paired up with our more experienced volunteers. This way, if they have  a question or are uncertain how to respond to a participant's complaint, they can refer to their partner for assistance.  

Supervisors

On duty from 10a to 10a

The supervisor has 2 main jobs:

1. Provide assistance, back-up, 2nd opinions, and/or overly-scrutinizing hyper-critical oversight in uncertain or difficult cases.
2. Communicates with the Board and Khaki if EMTs determine that the participant needs to go off-site.

Volunteers can call the Soup (FFFA supervisor) via radio. Soups may appear on scene from out of thin air if they find a certain call alarming or curious. Poof!

Shifts

The shift hours are as follows:

Day 8a-4p

Evening 4p-12a

Night 12a-8a

The night shift doesn't need to be awake during their shift. However, they do need to be arousable by radio.

If you can't stay awake for your night shift, you should consider drinking coffee/tea/red bull, eating raw cacao beans, or running around in circles singing at the top of your lungs with the windows open. Responding to Calls

Responding to Calls

Pick up your radio at the beginning of your shift from the Main Ranger Station. There you will meet your partner/s for the shift and you receive report from the off-going volunteers. Ask for radio training at sign in, if needed.

You can roam around with or without your partner for your shift.  But you must be able to hear your radio (so avoid those loud rave party sound systems!) and no ear plugs if you take a nap.

FFFA shares channel 1 with all Safety teams.

Be sure to make it clear on the radio when you are responding to a call - this keeps both the callers and your partner in the loop.

At the end of your shift, report back to the Ranger Station to return your radio and report on any continuing issues to the next shift.

Emergencies

In the event of an emergency, radio for the Soup(supervisor).

• Do not hesitate to Call for Help for all medical emergencies.
  1. The Soup is aware of all the resources available and in emergencies will take command while activating the ICS(incident command system).
• Radio for additional help from rangers, EMT ect as needed.

Sending Participants to the Hospital

Likewise, if you feel a Firefly needs to go to the hospital, radio for the Soup.

You may feel a Firefly needs to go the hospital for any of the following :

• Fall from Ladder or Tree
• Inhalation Injury (by Fire Breathing/Spinning, Camp Fire)
• Altered Mental Status
• Laceration/Exsanguination
• Dehydration
• Fracture
• Allergic Reaction

Etc...

The  EMT on duty will make the determination on whether to send the participant to the hospital, and how to get them there most safely - by ambulance or otherwise.

Resources

First Aid keeps a variety of tools for firefly participants to self administer if they felt they needed it.

Tick spoons for tick removal

pebto-bismol tablets for tummy sads

gloves for keeping yr mitts clean

advil - painkiller

benadryl - allergy medicine

tylenol - painkiller

eye wash kit for irritants in the eyes

alcohol swabs

cobain - stretchy bandages for sprains

paper tape - for holding gauze and bandages on

hand sanitizer

instant ice packs for pain and swelling

gauzes for cleaning wounds

bandaids of all kinds

hydrocortisone for rashes

tegaderm 4x4 for weepy nasty things like scrapes

burn gel for minor burns

antibiotic

Legal Issues

Few, if any, of our FFFA volunteers are licensed to practice in the state of Vermont.

We operate as Good Samaritans and as FFFA volunteers there is an expectation that we  we do our best in an emergency.  

Fireflies are the most grateful festival  population you can find. However, this is the real world, accidents happen, exploitations happen, it is best to prepare for the worst and hope for the best.

The following volunteer guidelines attempt to address the legal gray area in which we volunteer.

1) Insurance

Firefly carries its own insurance, and we recommend the healthcare professionals who volunteer for FFFA carry professional liability insurance for themselves as well.

That said, you are not practicing medicine, you are volunteering for first aid. At no time will you be asked to write a prescription or attempt to make a clinical diagnosis.

2) Scope of Practice

Due to the fact that we are volunteers, FFFA does not diagnose, prescribe, treat, or administer any medications. We do not do invasive procedures (like stitches, fracture reductions, etc...) We also should not do anything beyond our normal scope of practice.  As Firefly's first aid team, volunteers are often asked to give advice.  It is important that participants are told they are not being seen by a doctor, just a friendly FFFA volunteer.

Limit your advice to true first aid and refer participants to their personal doctor  if they have significant questions.

3) Waiver

This year we have embedded the waiver to receive first aid, with the general waiver all participants sign. We no longer need to request fireflies sign a waiver when we are on shift!  Yeah!

4) Situations in Which You are Bound to Act

• In an emergency 
Vermont's Good Samaritan Act legally requires action by anyone who responds to an emergency. FFFA has built the expectation in the community that we will respond to emergencies. Therefore, if you respond to a call and you need help, your minimum response is to call for help.  The EMT or Khaki will take it from there. 
Emergencies include unresponsiveness, obvious traumatic injury or uncontrolled illness, like a seizure.
• In a situation that could become an emergency
. We are not legally bound by Vermont's Good Sam Act to act. But, as previously mentioned, FFFA has created the expectation that we are trained for first aid and will respond and advise. Thus the minimum response is to refer to your partner and/or supervisor if you have any questions about the situation.

5) Operating Outside These Guidelines

Acting outside the official guidelines is not recommended or condoned by Firefly, Firefly's Medical/First Aid Core Leads or Supervisors, or other FFFA Volunteers.

Firefly cannot be responsible for wanton or errant practice by its volunteers.

It is extremely unlikely that you ever will feel pressured to act alone. Firefly has a number of resources available to you, as listed above. If ever you do not feel comfortable with a decision or situation, reach out to your partner and/or supervisor or ranger.  

Remember that everyone is grateful for the help our FFFA volunteers provide.  

For your protection, remember to

• Do not give medical advice, only first aid
• Refer to your partner and/or EMT when necessary  

Don't Forget to Chill Out

Always try your best to remain calm and collected during an emergency.  Remember to breathe.

Information can be difficult to process in times of stress. Emotions can run high, and communications can be curt, but always remember you are in control of your reaction.

Your reaction plays a part in the level of excitement and anxiety in any given situation.

Meter your tone, approach participants slowly and with permission when applicable, and be friendly and composed as often as possible.

6. What do we actually do, though?

We are people who will be available to help if someone has a medical emergency.

We are NOT there to play Mommy to competent adults.

We will give out first aid supplies to participants who need them.

We will NOT provide specialty treatments, comfort items, or advice.

We will be kind to participants who are upset or altered.

We are NOT therapists - emotional injuries go to Sanctuary.

We will be non-judgmental about decisions to do/try/ingest things that led to injury.

We are NOT trip-sitters, drunk caravan leaders, or a living set of crutches - that’s what friends, campmates, and the occasional Ranger are for.

We will ask the participant what they want to do, with regards to an injury.

We will NOT dictate a participant’s actions or perform any first aid without asking - if someone is a Problem to themselves or others, Khaki/EMTs are there to help.

Section 2: Common and/or Concerning Complaints

Allergic Reactions

Anaphylaxis is a severe life-threatening allergic reaction which involves 2 or more physiological systems. Common anaphylaxis-inducing allergens are peanuts, sunflower seeds, bees, and latex.

Signs and symptoms include:

• Wheezing
• Hoarse or whispered voice
• Difficulty breathing
• Tongue, lips, throat, and facial swelling
• Nausea, Vomiting, and/or Diarrhea
• Abdominal Cramps
• Red and watery eyes
• Runny nose
• Flushed skin
• Hives
• Itching
• Pale skin
• Weak, rapid pulse
• Low blood pressure
• Anxiety, confusion, sense of impending doom

If anaphylaxis is suspected, the participant needs to be seen by the EMTs immediately. They have epi-pens and will arrange transport off-site for the participant.

Ticks

Ticks are common at Firefly.

We stock tweezers and tick spoons to teach participants to be self reliant in tick removal.

There are a variety of folk remedies which are more-or-less useless.

• Burning a tick does not work frequently nor consistently.
• Suffocating a tick takes too long and, as such, does not necessarily decrease the chances of contracting Lyme.
• Digging a tick out with your dirty camping knife and leaving a giant open wound in your skin while you are unclean in the woods can lead to infection.
• Using tweezers inappropriately can cause the tick to regurgitate its stomach contents into you. (Mmmm! Tick vomit under your flesh - yummy!)

The CDC gives us the proper recommendations for removing a tick with the result of decreasing likelihood of contracting Lyme and other tick-borne illnesses (including Borrelia Burgdorferi, and Powassan Virus) We always get calls for tick bites

https://www.cdc.gov/ticks/

FFFA recommend the following methods of prevention:

• Daily tick checks - a tick must usually be attached for at least 24 hours to transmit Lyme
• Wear long-sleeved/long-legged garments
• Avoid fields of tall grass (which is where ticks like to wait for you to brush by)
• consider DEET/ and pre treating with permethrin.

We do not give or have  post-exposure antibiotic prophylaxis available on site.

Early/Initial signs and symptoms of Lyme include:

• Bull's Eye Rash (approximately 3-30 days after exposure)
• Fevers
• Body Aches

Later/secondary signs and symptoms of Lyme include:

• Joint Pain
• Joint Swelling

And late/tertiary signs and symptoms include:

• Weakness
• Numbness
• Other neurological symptoms

FFFA strongly recommends any participant who has a fever in the middle of July who was just in the New England woods, whether at Firefly or not, follow up with their doctor for appropriate diagnosis, treatment and advice.

Dehydration

Dehydration is common in people drinking lots of alcohol while dancing in the summer.

Other substances and circumstances which contribute to dehydration could include  unknown intoxicants, heat waves and infectious gastroenteritis.  On top of all that, most people do not drink enough water, but prefer to drink too much caffeine, which makes them pee more.

Dehydration can manifest with:

• dizziness
• lightheadedness
• rapid heart rate
• low blood pressure
• syncope/loss of consciousness

Complicating dehydration can be electrolyte imbalances, particularly sodium, which is lost in vomiting. Very low sodium can put people at risk for seizures, and we should be aware of this when helping someone who has been vomiting for a long period of time.

Diarrhea is a culprit for loss of potassium. Though unlikely in our firefly population, a very low potassium can cause heart arrhythmias.

If the participant is able to take fluids, remember to advise small frequent sips (1 oz every 15 minutes) until the vomiting stops. This will help them stay hydrated. Also remind them(or their friends) that vomit is MOOP and they must still take it with them when they leave ☺

Altered Mental Status/Unresponsiveness

There are a dozen reasons someone could be unresponsive and/or behaving abnormally.

Our main priority is, as always, to assess whether the person is maintaining an adequate respiratory and adequate circulatory status.

After we are reassured a participant is breathing/ventilating adequately and perfusing their organs with blood, we can consider the mechanism and the psychosocial safety.

Here are some commons causes and symptoms of altered mental status:

Head Injury

• Early signs:
• Known history of fall/head strike
• Headache
• Altered level of consciousness
• Nausea/Vomiting
• Late Signs:
• An unequal, non-reactive pupil
• Fixed and dilated pupils
• Impaired extraocular movements
• Slurred speech
• Facial Droop
• Unilateral weakness
• Slow heart rate
• High blood pressure (and/or widening pulse pressure)
• Irregular respirations (often shallow and rapid)

If a head injury is suspected, we also should be wary of a possible cervical-spine injury.

Moving an unresponsive participant after a fall could potentially worsen a cervical spine injury, causing paralysis of the diaphragm and subsequent death.

Unresponsive participants and possible head injuries must be seen by the EMT.

Opiate Intoxication

• Altered level of consciousness
• Pin point pupils
• Decreased respirations

Hallucinogen intoxication

• Altered level of consciousness
• Confusion
• Paranoia
• Hallucinations
• Delusions
• Dilated pupils
• Repetitive speech/"looping"
• Fragmented speech patterns
• Anxiety
• Increased heart rate
• Increased blood pressure
• Sweating

Ketamine

• Loss of motor coordination
• Loss of consciousness/unresponsiveness
• Confusion/Disorientation
• Slurred speech
• Increased heart rate
• Nausea/Vomiting

Serotonin Syndrome

(LSD, MDMA, hallucinogenic amphetamines, methamphetamine, cocaine)

-Cognitive Symptoms-

• Headache
• Agitation
• Hypomania
• Confusion
• Hallucinations
• Coma

-Autonomic Symptoms-

• Shivering
• Sweating
• Fever (104F, up to 106F)
• High blood pressure
• Increased heart rate
• Nausea
• Diarrhea

-Somatic Symptoms-

• Tremors
• Muscle twitches
• Hyperreflexia

Respiratory Distress

Difficulty breathing can result from many things.

Some we may be more likely to see are:

• Facial/airway burns (looking at you, fire breathers!)
• Asthma
• Anaphylaxis
• Decreased level of consciousness
• Intoxication
• High blood pressure

Facial burns represent a real life-threatening emergency, as the participant's tissue can swell rapidly causing total occlusion of the airway and resulting inability to perform CPR (necessitating a cricothyrotomy).

In facial burns, look for:

• Obvious burn to lips, nose, face
• Swelling to face, lips, tongue, uvula
• Singed nostrils and eyebrows
• Soot in nose
• Redness/blisters/soot in mouth/throat
• Hoarse voice

Respiratory distress needs to be evaluated by the EMT.

Fracture/Dislocation

Broken bones can be difficult to confirm without an x-ray.

Look out for:

• Obvious deformity
• Bone poking through skin
• Loss of function/ability to move injured area
• Pain with function and/or movement
• Pain with passive range of motion
• Bruise over bone
• Loss of pulse distal to injury
• Loss of sensation distal to injury
• Crepitus or "rice crispy feeling" to skin over area of injury

Suspected breaks need to be evaluated by the EMT.

Fractured Neck

Fireflies frequently climb wet ladders, trees, rocks, hills, or ride on a Polaris in order to climb slippery hills, rocks, trees, and ladders.

Falls are a real concern and can result in head injuries, fractures, and more concerningly, neck fractures.

Symptoms include:

• Apnea
• Difficulty breathing
• Loss of sensation below the level of injury
• Paralysis/Loss of function below the level of injury

If you are concerned a participant has a fractured neck, do not move them!