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 on the shelves in the First Aid Tent, across the path from Radios, which is behind Ranger HQ. These are bags with basic supplies to use on your shift. Take one at the start of your shift, check the supplies, and adjust the contents based on what you are comfortable using. Return it to the tent at the end of your shift, after taking out any trash.

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 are 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

Pick up your radio at the beginning of your shift from the Radio Station, behind Ranger HQ. Go to the First Aid Tent next door, where you will hopefully meet your partner/s for the shift and pick up a bag of supplies to carry. Ask for radio training at Rangers, if needed. Keep your radio on and at sufficient volume - this can change if you go to a dancefloor! Walk around and enjoy the event (sober, please) or hang out in the First Aid tent, your choice, just be ready to go to the location of an injury or the First Aid Tent, if you get a call.

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

FFFA has a dedicated radio channel. Be aware of which channel EMS services and Rangers are on, if you need backup.

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, make a report over the radio of what happened on your shift - the leads and soups are listening. Report back to the Radio Station to return your radio.

Please make a note on the whiteboard inside the First Aid Tent of the number of injuries and their type that you responded to.

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 etc as needed.

Sending Participants to the Hospital

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 Lead vehicle.

Participants who are reticent to take an ambulance should be advised that the Leads have access to a personal vehicle for the transport of participants to and from Urgent Care or the ER. It is not a taxi to CVS for bug spray, but it is an important resource for those Fireflies who can't incur the cost of ambulance rides. In the event of life-threatening status changes, an ambulance must be called. However, Fireflies should be told that they may be transported to get an x-ray or a few stitches in a dedicated First Aid "jump" vehicle if they require, and cannot secure their own rides.

Any Participant who needs to exit for health reasons is permitted to return to the event, and their transport people are also permitted to return. First Aid volunteers should radio Gate and let them know the names and numbers of participants who are leaving to clear them for re-entry.

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

Ibuprofen - painkiller

Diphenhydramine - allergy medicine

Acetaminophen - 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

Antiseptic soap and wash bottles for cleaning

Extra supplies are in the clear tote bin in the First Aid Tent.

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 will 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 medical 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.

Foreign Body in Eye

Take a look at the eye. If you see a small thing stuck on the surface of the eye, you may help the participant to gently flush the object out with our sealed, sterile Eye Wash bottles. Do not use a bottle with a broken seal. Do not pick the object out with a towel, gauze, tweezers, your fingernails, or your tongue. If the object will not move out of the eye, send them to EMS. If there is no visible object, tell the participant that scratches on the surface of the eye often feel like an object, and tell them to wait and see if it feels better in a few minutes. If it does not, send them to EMS. Throw the opened wash bottle away if the participant does not want to keep the remainder for themselves - they are One Time Use.

Minor Skin Breaking (Cuts, pokes, scrapes, splinters)

We have a wide variety of gauze, bandaids, tape, and occlusive dressings. If the participant has a splinter, they may use the tweezers on top of the black box in the tent - please clean them with hand sanitizer before and after. The participant should clean the wound with Hibiclens antiseptic soap (just a little goes a long way) and water. We have wash bottles which may be filled with clean drinking water at rangers - please fill only as much as you need, and dump the bottle when done. Mold grows fast on warm days. Allow the wound to dry or use a gauze square, then the participant may bandage and apply antibiotic ointment as they prefer.

Ticks

Ticks are common at Firefly.

We stock tweezers and tick spoons to teach participants to be self reliant in tick removal. Tip: A small piece of tape applied to the handle of the spoon, sticky side flap hanging over the bowl of the spoon, can help catch the tick as it comes free of the skin.

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)

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 repellents 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. Make sure they are breathing and have a heartbeat. If there's any doubt about either of those things, call EMT immediately.

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.

Completely unresponsive or unconscious 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 evaluating 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. First Aid may transport these participants to outside services if the break is not suspected to be life-threatening and is not causing an open wound or loss of circulation.

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! Call EMT and stand by to prevent other participants from moving them or disturbing them.

Our Working Relationship with the EMT team

First Aid volunteers are expected to be respectful of our paid EMT team. We do not argue with them, even if we hold a hospital practice license like MD or RN. At Firefly, they are the final authority on medical issues on-site, because they are legally allowed to treat patients and we are not. They have saved the lives of Fireflies several times, so the most important coworking task we volunteers can perform is this: Let them work, and do whatever is necessary to make that work easier.

This includes, but is not limited to:

• Diverting as many minor injuries to our care as possible, so the EMTs are free to respond to bigger things.
• Making a path to, and forming a barrier around, a participant who needs EMT help.
• Body blocking or telling off the Looky Lous who want to spy on a participant in crisis.
• Providing any and all supplies we stock to the EMTs if they need more - they are very well stocked, but the worst injuries will go through all the gauze very quickly.
• In the event of a Big Deal (a participant requiring resuscitation or stabilization by the EMTs), First Aid volunteers who are not needed at the scene should go to the First Aid tent and interrupt any participants who attempt to get to the EMS tent. No, a twisted ankle may not wait in the EMS tent when there is an inbound Big Deal - First Aid has comfortable cots, and the participant is welcome to find transportation to a hospital.

If you really believe that a participant is not receiving appropriate *medical* care from the EMT team, radio your soup or go directly to Khaki with your concerns.