• Help learners understand the risks they may face by encouraging them to think about the possibilities relevant to their context. Each of these types of factors influence how they should plan and what they need in their preparedness kit. Consider:
> hazards and their impact such as whether a person lives alone or with a family
> whether there are children or someone with mobility issues
> if they live in a tall building or a house.
Learner considerations
• Make time to explore the responses people might have to a disaster such as experiencing high emotions or filming it on camera. Discuss how to manage emotions and the positive or negative outcomes of behaviours.
• Educate groups that act as a community – such as those in workplaces, schools and community centres. Involve local emergency services when possible (Wynch et al., 2011).
Facilitation tips
• Emphasise that individuals can play a critical role immediately after a disaster as the time it takes for emergency medical services (EMS) to respond can vary enormously from hours to days or even weeks (Jacobs et al., 2016).
• Concentrate on bleeding control, maintaining an open airway and shock. A focus on simple steps for stabilising life-threatening conditions is paramount (Bazeli et al., 2017; Jacobs et al., 2016; Loftus et al., 2018; Turner et al., 2018).
• Emphasise the importance of infection prevention, especially as first aid supplies may not be readily available.
• Stress the importance of learners applying all the first aid steps which are possible to reduce pain and suffering and further harm, even when it is not possible to apply all the steps in a particular context or situation.
• Emphasise the role of bystanders as immediate responders and build learners’ confidence to act, alongside their skills and knowledge.
• Encourage communities and families to prepare for disasters by creating their own disaster preparedness kit to meet their basic needs for the first three days after a disaster. Kits are filled with essentials such as a torch, water, and toiletries and are kept in a place where they can be quickly accessed. Make sure everyone knows the location of their emergency kit.
• Encourage learners to improvise in the likelihood that first aid supplies are unavailable or inaccessible (Gordon et al., 2019; Jacobs et al., 2016; van Romburgh & Mars, 2019).
• Consider building these sessions into preparedness education:
> scene safety
> size and scope of the disaster and identifying immediate needs
> resource assessment for short, medium and long term
> available help (e.g., bystanders or EMS)
> what level and type of triage is possible (both according to the skills of the provider and the needs of the ill or injured people).
Facilitation tools
• The Global Disaster Preparedness Center is a reference centre to support innovation and learning in disaster preparedness. Visit preparecentre.org to learn more about citizen preparedness for disaster.
• Practical exercises or role-play scenarios are an important part of disaster preparedness. These exercises should include focusing on the safety and security of first aid providers and the people they are helping.
• If programme designers have access to country-specific preparedness apps, they should consider using these to prepare the population and motivate them to learn first aid.
• Help learners develop their own emergency plan. It is important to ensure that everyone is prepared and informed in the event of a disaster or emergency. A family group may not always be together when these events take place and should have plans for making sure they are able to contact and find one another.
> Determine the best ways to evacuate your home in case of an emergency such as a home fire, as well as a safe place to meet.
> Know the plans for your workplace, school, community centre, etc. in the event a disaster happens when you are not at home.
> In the event of a disaster, listen to local radio and television. If local officials or community leaders ask you to evacuate your neighbourhood, follow the routes and go to the location specified. Do not take shortcuts as they could take you to a blocked or dangerous area.
Scientific foundation
Papers for this review were sourced from the original literature search for qualitative and quantitative insight on first aid education and supplemented with insight from experts in the field who were also able to suggest additional evidence sources.
Understanding disaster contexts and the varying impact of different hazards
Johnston et al. (2014) and Salita et al. (2019) explored why disasters happen and how to characterise them, providing insight into the likely injuries and harm caused. Both authors draw on the Extended Parallel Process Model of Behavior (Witte, 1992 &1994), which proposes that increasing personal efficacy and threat perception encourages attitudes, intentions and behaviours that can lead to improved disaster preparedness in individuals. In other words, training people how to respond, instilling the willingness and ability to do so, and clearly communicating the threat level of different disasters can better equip people to prepare for disasters. The training links a person’s belief that their actions will help to control the situation (either the danger or the fear they feel) and affect its outcome (Ejeta et al., 2015). Understanding context, including site-specific hazards, the available help and how to access it in real-time, can be important for preparing populations for disaster.
Integrating lay response with the emergency services
Studies from different countries have highlighted a shared challenge of integrating response systems and the ability to make use of lay responders. Bazeli et al. (2017), Leow et al. (2012) and Turner et al. (2016) identified the problem as existing between the response agencies where lack of coordination, delineation of duties and other deficiencies reduce the effectiveness of the response. The Institute of Medicine’s workshop on Medical Surge Capacity in 2010 articulated the barriers to gaining acceptance from emergency response agencies for increased first aid training and lay responder roles (IOM, 2010). Participants identified the need for public preparedness training and for public involvement in the research and development of communication strategies. However, they also pressed the point that this would only be worthwhile if EMS had already engaged with the public. Public training that is endorsed or supported by EMS providers could help to minimise the disconnect.
Motivation to act
The public needs to understand how they can help (and not hinder) a response and what factors will affect their motivation to respond. There is an emerging body of evidence on the motivation to respond. See Miller and Pellegrino’s paper on Intent to Aid (2017), Jacobs et al.’s paper on empowering the public through the recognition of their critical role (2016), and Pellegrino and Asselin’s paper on motivations to learn first aid (2020). Oliver et al. (2014) and Muise and Oliver (2016), both explore the need to develop the confidence and willingness of learners within first aid courses, as well as their skills and knowledge. These papers do not consider disaster on a significant scale, but the findings could apply across large scale and more personal disasters.
Wynch et al. (2011), in their paper on reflections of the community response following Hurricane Katrina, found benefits to training people in identified communities (such as workplace teams). They found that working together in a real situation, as they had trained for, fostered pride, professionalism and humbleness. The paper concludes with a recommendation to policymakers to consider this kind of community engagement when planning education and building community resilience.
The Institute of Medicine focused on the role of media and effective communication to promote preparedness and resilience messages to the public as a mechanism to generate a response. In their notes from a workshop in 2015, they explicitly recommend that emerging media types, branding and promotion are essential tools to mobilise individuals and communities to engage in disaster response. Wilson et al. (2005) reported a strong use of media to inform the public in New Zealand on how to respond to a flood emergency. See the section on Media learning within the Education chapter of these Guidelines for more information.
Focus of first aid education for disaster preparedness
Several authors focused on the crucial elements of first aid education when considering disaster preparedness. These are:
• Bleeding control, open airway and shock: Focus on the critical importance of simple steps for stabilising life-threatening conditions (Bazeli et al., 2017; Jacobs et al., 2016; Loftus et al., 2018;
Turner et al., 2018).
• Injury prevention and infection control in the early recovery phase of a disaster: Focus on safety and implementing methods to prevent a dependence on the professional healthcare system (Johnston et al., 2014).
• Leadership: Encourage leaders to feel confident and organised enough to distribute lay and professional responders’ skills and willingness to engage in a broad range of areas after a disaster (Kay, 1984).
• Refresher training: Use methods such as digital games to regularly reinforce skills and psychological preparedness for unexpected emergencies (Cicero et al., 2018; Mohamed-Ahmed et al., 2016; Turner et al., 2016; Wilkerson et al., 2008; Yanagawa et al., 2018).
• Improvisation: Incorporate training that encourages learners to improvise when first aid supplies are unavailable or inaccessible (Gordon et al., 2019; Jacobs et al., 2016; van Romburgh and Mars, 2019).
• Memory aids: Suggest using an app or carrying an information card in a wallet. First aid providers might be reassured to know that professional responders consult checklists en route to (as well as during) an emergency (Motola, 2015).
• Human factors: Understand how human factors affect communication, leadership and teamwork (Hunziker et al., 2010).
Understanding human response to disasters
Ejita et al. (2015) examined articles on behavioural theory and how this applies to human response during disasters. Studies that consider how human factors affect the response, particularly for medical response teams, is currently a gap in the Guidelines. However, we anticipate further work on this topic in relation to first aid education.