BRINGING SAFETY TO THE STREETS

Fionna Douglas observes how the St John Ambulance is teaching young
people basic first aid for friends who 'drop' after an overdose of
drugs.

"I WAS with my girlfriend - we'd been using. She walked out of the
room, into the kitchen and dropped. She went blue real quickly. I knew
what to do. I rolled her on to her side - I think that's called the
recovery position, yeah? And checked her throat was clear and she was
breathing. Then I called the ambulance. When the ambos came they said
I saved her life. They were quick - only five or six minutes, but if I
hadn't done what I did she probably would have died."

Bill's girlfriend Sarah had overdosed. Losing consciousness - or
dropping, as it's called - is a major risk. And if there's no-one
around who knows how to help, it can be fatal.

Sarah, watching from a distance, confirms the story. "Yup, he saved my
life." She's proud and lucky. Bill completed a first-aid course
several years ago, and remembered what to do in an emergency.

The tragedy is that very simple first-aid procedures could save many
young lives every year, but few users have the knowledge they need to
stay alive. It is a tragedy St John Ambulance is trying to address
through Project Survival.

The night Bill was telling his story was just another Friday night at the
Late Night DRIC Youth Program, the Drug Referral and Information Centre in
Canberra City. A room full of young people - under-25s only on Friday
nights many of whom live on the streets, had gathered for the free healthy
food, the materials needed for safe injecting
and the free medical, legal and first aid. This Friday it's first-aid night.

Sophie Pinwill is the Youth Project Officer who manages the program
funded by the ACT Department of Health and Community Care. Tonight
she's cooking tacos and making salad.

Most kids eat, watch a bit of telly and move on. A few, interest
sparked by the sight of a plastic manikin being fitted with
plastic-bag lungs, ask what's going on. This Friday night the St John
Ambulance volunteer is Bronwen McCrohon. She is sitting on the floor,
preparing the manikin, smiling, talking about life and gradually
bringing every conversation around to first aid.

Bill tells Bronwen he's done a course, he knows what to do. Bronwen
persuades him to run through the basics again. They start with Dr ABC.
Bill starts off well. Yes D is for Danger - to yourself to the
casualty, to others. That's where you start.

"And what do you look out for?" asks Bronwen.

"Needles," says Bill.

Obviously.

They move on. R is for Response. "Shake and shout at the casualty,"
says Bronwen "to find out if they're asleep or unconscious. And he
careful how you do it - you might get whacked if you wake someone up,
so start by shaking the casualty's feet - it's safer that way."

Now Bronwen is lying flat on the floor demonstrating being unconscious
and ready for the next stage - when Bill will remember that A is for
airway and he needs to place Bronwen in the recovery position.

People pass by, occasionally briefly interested, but losing interest
quickly, needing more time to get used to the idea. Tonight some are
anxious about what is going on. Why is there a photographer around and
what am I doing making notes?

I tell them we think first-aid training is important, it can save
lives. I want to let other people know what Bronwen and her fellow
volunteers are doing, because it makes so much sense and because it
makes a difference.

Fair enough, they say. Everyone here could do with a mate who knows
first aid.

A young girl with beautiful eyes wants to talk.

"I knew some people," she volunteers in between mouthfuls of tacos.
"They were 14 or 15. They were using. One of them dropped, outside.
The others stayed with her for 40 minutes. They knew some first aid.
They did resuscitation and everything else right. She was OK, she came
round. She was lucky, she could've died. But nobody called the ambos."

Liz is confident, articulate and street-smart. She looks as if she
could be holding down a job in a legal firm, but she's been living on
the streets of Canberra for more than seven years. She's familiar with
all the warm spots in winter, and with all the risks.

Why don't they call the ambulance?

"Because of who might turn up with them, the cops."

The St John volunteers try to tackle this issue as well. "We always
discuss how to call an ambulance successfully," says Bronwen. "It
seems like such a simple thing, but sometimes when young peopie OD,
they are not at an address - they might be at an isolated park, or
under a bridge. It is important for the peer group to be able to
identify the location precisely so that the ambulance officers don't
waste time trying to locate them. It is also essential that they seek
expert help. There is this resistance to calling an ambulance. We talk
a lot about that and how you've got to ask for the experts, you've got
to get help if someone has dropped."

The idea for Project Survival began in the early 1990s, when a
particularly potent batch of heroin hit the streets in the ACT. quite
a few young people died, and the Coroner found that some of those
deaths might have been avoided if the peer group had known what to
do.

St John recognised that people in this high-risk group did not - and
probably never would come to a formal first-aid training course - yet
they would of ten need basic life-saving skills.

A pilot project, developed by St John volunteer Greg Cranswick, called
Street Kid Survival, was launched in the early 1990s. St John
volunteers went to places where kids congregated - bus shelters,
parks, shopping malls. They took a resuscitation manikin and waited
till kids approached them.

Project Survival followed. Much of the training is now carried out in
youth refuges, drop-in and detox centres, needle-exchange and
detention centres and youth groups.

Peter Parkes, a youth health worker, has been working in the project
for several years. He is on the AIDs bus tonight but drops by for
dinner and a chat. He was, he says, the person who first contacted St
John about the first-aid idea: "We were losing so many kids, teaching
then how to deal with this stuff seemed like the obvious way to go."

And has it worked?

"It's hard to measure," Peter says. "I hear anecdotal evidence about
kids doing [Expired-Air Resuscitation -mouth-to-mouth] all the time,
but how do you measure how many lives you've saved? In the years the
project has been running there has been a big increase in the number
of users on the streets, a big increase in the number of overdoses and
no increase in deaths, so we must be doing something right. But we
still lose about 12 people every year."

The exact figures on drug use in the ACT are difficult to obtain for
obvious reasons. But a realistic estimate based on the number of
peopie using needle exchanges is 3391 users. And the trend is clearly
up. Thirteen per cent more needles were distributed in 1997-98 than in
1996-97.

THE FIGURES on drug-related deaths are more positive. According to the
ACT Coroner's Office there was only one under-25, accidental,
drug-related death in the past 12 months. There were two more deaths
in people aged between 25 and 30 and a total of 14 drug-related deaths
in the territory over the year. In the previous two years there were
38 drug-related deaths.

By now Bill has finished his refresher training. He gets a pack
including plastic gloves, a face mask and a laminated wallet-sized
card with information on resuscitation rates, and a range of useful
contacts and numbers. And he gets a certificate -that pleases him.

Liz is doing a refresher first-aid course now. She is practising the
resuscitation techniques, chatting with Bronwen, hearing the "call the
ambos" message and the "be careful of blood" message. "Don't get
anyone else's blood on you - there's a Hep-C risk".

Towards 8pm the early crowd has drifted back to the streets. Bronwen
has time to talk to me.

In daytime she is a pre-school teacher and a parent of three
teenagers. She spends a couple of nights a week on Project Survival.

Why? "Well, I think I'm very lucky. I've got kids and they're great,
they're living at home. I hate the thought of kids dying alone and I
wouldn't want that to happen to my kids.

"But the real truth is that I enjoy it; you meet some great people.
The kids appreciate what we're doing. They come up and talk to me in
the street and tell me about when they've needed resuss skills - it's
great."

Project Survival now has six seasoned volunteers and five recruits.
Most are involved in two or three training sessions a month, sometimes
one-on-one, like tonight.

"The people we see almost always suffer from low self-esteem, they
feel that their options are limited and certainly, doing a full
first-aid course would be out of the question," Bronwen says.

"We teach basic life-saving skills, but the impact on their
self-esteem is just as important. Many of the kids see themselves as a
bad person, many of them are very withdrawn. If I can persuade them to
have a go, to try resuss, they really start to open up. They gain
confidence knowing that they know what to do in an emergency.

"Even the certificate helps build self-confidence. I remember a man in
his 30s having tears in his eyes when I gave him his certificate. He
told me it was the first certificate he had ever earned and it was the
first time he felt that he had achieved something.

"I've seen young people just come alive when they are told that they
can do EAR really well. We often ask people in the group to
demonstrate to the others and this has proved a valuable strategy.

"Learning the skills often means that the young people have more
confidence. This empowers them to act rather than turn and run when
things go wrong."

She recalls one young man telling the group that he had suffered a
stroke, and his companion at the time had panicked and abandoned him.
It was two days before anyone found him. He is not in a wheelchair,
but has limited movement on one side.

"He said that had his companion known what to do, his situation today
might be different.

"One of the most telling comments about the value of our work came
from a young man in a training group recently. He said, 'If you're
gonna do drugs, you have to do this stuff.'"

The names of the young people in this story have been changed to
protect their privacy.

Checked-by: Patrick Henry