Tom Koch is a medical geographer at the University of British Columbia and author of Ethics in Everyday Places: Mapping Moral Stress, Distress, and Injury.
At an accident or natural disaster – earthquake, flood, hurricane, or tornado – your initial responder likely won’t be a professional first responder. It will be, if you’re lucky, an engaged bystander.
After all, in most cities, in the best of circumstances, it can take five to 15 minutes for a paramedic to arrive after being dispatched by a 911 call. If the bridges are down, the roads blocked and traffic is at a standstill – or if your need for medical attention is shared by others in a mass casualty event, it will take far longer. What could help in the interim is a citizen responder who knows what to do until a first responder arrives. It’s not advanced medicine, but basic first aid can mean the difference between death, permanent injury, or recovery following comprehensive care.
Ever since the Heimlich manoeuvre to free the airway of someone choking on food was first published in the Journal of Occupational Medicine in 1977, tens of thousands who would have otherwise died from choking have been saved by citizen responders. It is part of a suite of basic procedures that some advocate should be taught to all. Other techniques include cardiopulmonary resuscitation (CPR) – manually and with a defibrillator – as well as what to do in case of a seizure, and basic first aid. More advanced techniques include procedures to immobilize a fracture and control bleeding.
After years of work in chronic and palliative care, I can say that I know the value of learning such procedures. I have attended three cases of heat exhaustion, three seizures (one grand mal, two petite), a broken collarbone, three possibly broken limbs (they needed to be X-rayed) and, twice, a collapse that might have been a heart attack – or might have been something else. I became involved simply because I was there.
There is a need for more ordinary citizens to be able to engage and respond when they are similarly present at such situations. That’s why, in 2014, a committee of the American College of Surgeons concerned with survival after mass-casualty shooting events recommended programs for citizen responders. “Everyone can and should be an initial responder,” Dr. Lenworth Jacobs, Jr. wrote in the committee report. “Everyone should be taught hemorrhage control.” And it works, according to a study by Dr. Craig Goolsby in the journal Academic Emergency Medicine. Average citizens can be taught the basics, and perform them if required.
Such training needs to be widespread, and it can start in our schools. In the United States, for example, states such as Washington and Michigan have mandated CPR training in high schools in recent years – estimated to translate into the potential to save hundreds of lives per year. Many Canadian students are also trained to perform CPR, but it is generally not mandatory as a graduation requirement. Moreover, CPR, while important, is only one part of a larger toolkit.
Consider, instead, the new First Aid for Severe Trauma program, developed under the National Center for Disaster Medicine and Public Health (NCDMPH). Designed for U.S. high school students, it teaches simple but decisive lifesaving actions grounded in part in the experience of treating soldiers on the battlefield. Participants are taught “scene awareness” – how to assess a situation and categorize those who are stable and those in urgent need of attention. They also learn techniques to stop bleeding at a wound site with direct pressure or, if needed, a tourniquet. There are also lessons on communicating on-scene information to emergency dispatchers and personnel. This gives professional first responders, when they arrive, key advance knowledge of potential patient needs.
Canadian schools and universities need to develop similar programs encouraging such training – and perhaps even mandating it as a requirement for graduation. The benefits would be twofold: Besides the potential to save lives, this kind of training teaches the learners to be actively engaged with others in the community.
Equipped with these skills, those who encounter an emergency situation will not simply stand and gawk, but rather take active control, assisting the injured and co-ordinating with professional first responders when they arrive. Ultimately, ensuring capable citizen responders also means building an active and engaged community – something that’s perhaps as important as the practical lessons themselves.
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