General approach
Key action
Provide help while maintaining your safety, as well as the safety of the ill or injured person and any bystanders.
Introduction
The actions of the first person on the scene of a first aid emergency are critical. While providing first aid is important, it is only one aspect of the Chain of survival behaviours. It is important to observe and practise other aspects within first aid education programmes too. While actions may be numbered neatly in steps to take, in reality, many may be done simultaneously. For example, if the first aid provider has a phone, they could call emergency medical services (EMS) using the speakerphone function while still providing care.
Underpinning the Chain of survival behaviours is the safety of the first aid provider and their ability to make decisions to act effectively.
Good practice points
Assess the scene
• First aid providers should be taught about ambiguity in emergencies, and how deciding to act is the most important first step.
• First aid providers should assess the scene for dangers to themselves or others before providing help.
• In assessing a scene that contains areas of danger, first aiders should also observe which areas are safe (or have fewer dangers) to provide options for themselves and the ill or injured person.
Assess the person
• A standard approach to assessment could be taught to first aid providers. This may help them appropriately prioritise care for time-sensitive conditions and feel more confident in their approach.
• If possible, first aid providers should approach the ill or injured person from the direction they are facing so they can see them coming. This may reduce the risk of scaring the injured or ill person or causing them to move unnecessarily. It may also help keep them at ease.
• First aid providers should assess the ill or injured person by checking for a response, normal breathing and normal blood circulation. These conditions should be treated as a priority if abnormal.
• If the ill or injured person can talk or cry, it should be assumed their airway is open and their breathing is adequate.
• An ill or injured person should be left in the position of most comfort (usually the position that they are found) unless there is a need to move them to a different location or position for safety or wellbeing purposes.
• First aid providers may assess an ill or injured person further by asking them questions to determine their mental status or medical history or more closely examining part of their body (with consent).
• The first aid provider should communicate with the ill or injured person, explaining what they are doing to help, and acting with respect and empathy.
Provide care or access help
• The first aid provider should access emergency medical services (EMS) as soon as they think help is needed. If using a phone, care to the ill or injured person should be provided simultaneously by activating the phone’s speaker function.
• A lack of first aid equipment should not be a barrier to providing care; first aid providers should use whatever resources are available to them.
• Filming an emergency incident is inappropriate, particularly if it blocks the path of professional responders. First aid education should raise awareness of this fact.
Multiple casualties
• The first aid provider should protect themselves at all times from danger, aim to preserve life and reduce injury and suffering.
• If there is more than one ill or injured person, it may be appropriate to call EMS first to inform them about a potentially critical situation, and then repeat the call once more detailed information has been gathered.
• In a multiple casualty incident, the first aid provider should assess the ill or injured before providing care and provide care first to those people with the most life-threatening conditions relating to breathing and circulation.
Chain of survival behaviours
Prevent and prepare
• Know the common risks in your environment, and the steps you can take to help minimise the risk of an incident occurring or worsening.
• Ensure you have access to a first aid kit or the specific equipment (a disaster kit, hi-visibility signs or clothing, etc) according to your assessed needs and risks.
• Be aware that diffusion of responsibility (e.g., thinking someone else will help) and ambiguity (e.g.
wondering if the person really needs help) are common barriers to overcome in helping an ill or injured person.
• Learn the emergency services that can help in your context and how to access them. This may involve knowing their phone number, location or the types of questions they may ask.
• Understand the potential resistance an ill or injured person may have to certain procedures, such as the associated costs of services. Advocate for them accessing care when it is needed.
• Learn proactive means to de-escalate volatile situations (See De-escalation techniques).
Recognition
Upon entering a first aid situation, be aware of the thoughts and feelings you may have that may affect the help you provide. Be alert to the fact that people read situations differently, and just because no one is responding does not mean that nothing is wrong (the Bystander Effect).
Assess the scene
A scene assessment involves identifying any potential safety risks (to you, the ill or injured person or bystanders), such as fire or exposed electrical wires. The location itself may be unsafe. If the person is in or near a body of water or ice, in a conflict area, or a closed or confined space with minimal oxygen or poisonous gas, extra care must be taken. Additionally, if there is an active shooter, contamination by chemical, radiological or biological agent, or any other risk you can’t mitigate, stay away and inform the relevant authorities (fire or police).
• If possible, seek the support of another person who can help you.
• Assess the scene for potential danger to yourself or the ill or injured person and try to identify the potential cause of the illness or injury.
• If necessary, observe areas of safety (or ones with fewer dangers) to provide a safe place for you and the ill or injured person.
• Take steps to make the scene safe. This could include accessing additional help or equipment or by changing your approach based on the danger. Do not approach the scene if it is not safe.
• Identify the number of ill or injured people.
• Remain aware of your surroundings and maintain your personal safety. This will be particularly important in Conflict, Disaster or multiple casualty contexts.
Assess the person
Remember to talk to the person as they may be able to indicate what is wrong. Always act with empathy and respect. Tell them what you are doing before you do it.
Identify any life-threatening emergencies requiring immediate action (e.g., the person is not breathing) and what kind of first aid can support their condition.
1. Is the person responsive?
2. Is the person’s airway open and clear?
3. Is the person breathing normally?
4. Has the person got an injury that is bleeding severely?
This is often called the ‘ABC check’ or ‘primary survey’. If there is any concern about cross-infection, do this assessment by observing the person’s chest or abdomen for signs of breathing. See Pandemic.
If the person doesn’t have any life-threatening conditions, you may be able to identify and provide support for any non-life-threatening conditions.
1. Is the person showing signs of an altered mental status (confusion, aggression, etc)?
2. Does the person have any signs of injury? You may need to examine them more closely.
3. Does the person have any history of an allergy or medical condition?
4. How does the person say they feel?
5. What other signs can you observe in them (temperature, movement, etc)?
First aid steps
1. Provide care for the conditions you find in the order of severity, focusing first on the person’s breathing and circulation which are critical to survival.
2. Access help if necessary.
3. Continue to assess and observe the person. Be alert to any changes in their condition. Take note of any vital signs if necessary.
4. Provide care until professional medical care can take over or the person and their support network become self-sufficient. It may be helpful to signpost to onward care options if available.
Access help
• Identify what type of help is needed. It may be more than one type of help. For example, rescue service and medical care. Or it may be that you access the next available higher level of care to you.
• Access emergency medical care as soon as the need is suspected. This will get help to you quicker, and if you are phoning, the call-taker may be able to guide and support your first aid actions.
• Identify additional resources that could help you in accessing help or providing care, such as bystanders or transportation options.
• If lifesaving first aid is being provided, access care in the most efficient way possible. This may mean making a call using the speakerphone function, while others may need to arrange transport that allows care to be continued during transportation.
• In some cases, it might be better to access EMS quickly with incomplete information. For example, accessing EMS early for a full bus crash, even without knowing the exact number of injured will start the process of getting help. In other contexts, more detailed information may be needed. For example, a messenger sent in a remote setting should have detailed information so EMS can send adequate resources to help.
• If calling EMS, remain calm and answer their questions as clearly and accurately as you can. This will help them prioritise your call.
Education considerations
First aid education can increase the likelihood that a person will get the help they need in a first aid emergency. Education can increase a learner’s intention to help by supporting them to develop confidence and willingness to act. This confidence and willingness may be increased by including helping behaviour messages and activities which span the whole content of an educational intervention, including the general approach to providing care in an emergency.
Context considerations
• Assessing the scene for danger will vary considerably across contexts. Discuss with learners the types of incidents they are likely to encounter (road traffic collisions, accidents at work or in the home, conflict etc).
• The role of the first aid provider will also be affected by who else is likely to be on the scene at the time, and this might facilitate or inhibit intervention (Levine et al., 2020). For example, their response might be different if they are alone, if they are with a colleague who can help them, or if they can enlist the help of bystanders.
• The role of the first aid provider might also be affected by the behaviour of other people, and the relationship of the rescuer to those other people. In some contexts (usually ambiguous, non-violent ones), the Bystander Effect can occur where no one responds to an ill or injured person because no one else is doing anything to help (Van de Velde, 2009; Levine & Manning, 2013). In other contexts (usually unambiguous, violent ones) there may be a ‘reverse Bystander Effect’ with bystanders coming together to respond (Fischer et al., 2011, referenced by Levine et al., 2020).
Multiple casualty incident
• If there is more than one ill or injured person, call EMS first to inform them about a potentially critical situation, and then call them again when you have detailed information to give them.
• Quickly assess all the ill or injured before providing care and provide care first to those with the most life-threatening conditions relating to breathing and circulation.
• The type of help available will vary based on local factors. Programme designers should ensure their programmes reflect local circumstances. Be aware that help might not be available for all locations or contexts. Learners should be aware of what is available. For example, an urban area may have easy access using an emergency phone number. However, a remote area in the same country may not have access using the same phone number. This may be even more complicated if people travel between the two contexts.
• Be aware of myths and realities that may exist in local areas that may influence efficient access to care. For example, local taxis might provide faster transportation than ambulances, or this could be a perception which hinders efficient access to care (Jayaraman et al., 2009; Mould-Millman et al., 2015).
• If there are any barriers to accessing care in a particular context, programme designers should ensure that those barriers are addressed in learning activities (Watts et al., 2011). For example, an emergency phone number may offer language translation or text services, allowing those who do not communicate in the dominant language to still seek help.
• Raise awareness that some first aid situations may be solved by helping the person connect with their usual care providers.
• Prepare learners for the type of incidents they are most likely to encounter. For example, in areas where there are frequent traffic collisions, learning should reference these and identify the level and availability of emergency services and others who can help.
• In preparing people for events such as terror attacks, include individual safety measures and local regulations in the first aid education.
Learner considerations
• Encourage learners with sensory or physical disabilities to consider how they can complete the assessments of the scene and the person in a way that works with their strengths. Also, work with them to devise strategies that they can use to safely move a person without injuring themselves in the process.
• Work with learners to develop strategies to overcome fear when faced with an emergency. Use educational approaches which encourage confidence and willingness to act according to learner needs and preferences.
• Seek to understand learners’ intentions to act and their motivations or barriers to doing so to make your educational approach effective (Miller & Pellegrino, 2018; Herd et al., 2020; see Motivation to learn topic).
Facilitation tips Assess the scene
• First aid providers find it most difficult to decide to act. Learners should be taught about ambiguity and how deciding to act is the most important first step (Vaillancourt et al., 2008).
• Guide learners to reflect on their own experiences with helping in the past. The theme of ambiguity and the Bystander Effect may come up in stories shared by learners (or the facilitator). Bringing up these themes as lived experiences will help learners who have not experienced these feelings to relate to these concepts.
• Since there are a large number of potential safety hazards, focus on the principle of scene assessment: identify and manage dangers. Allow learners to identify potential dangers within their contexts, as well as solutions that they would consider. (See Scene assessment resource.)
• Focus on how learners can eliminate, control or work around potential dangers. Avoid focussing on what learners should not do when faced with danger as this may discourage any action instead of encouraging safe action.
• Supplement discussion of potential dangers with specific instruction for any risks where the probability of the risk is high or where there is misinformation present. Consider the work and guidance of other programs (both inside and outside of the Red Cross Red Crescent) to ensure synergy.
• Depending on the situation, the first aid provider may need to decide whether to move the ill or injured person. The first aid provider should only move the person if they are in danger, need to travel to medical care, or if the person is in a position that makes it difficult to assess and provide care. First aid providers will need to balance the risk that may be caused by moving the ill or injured person, versus the risk of not moving them.
Assess the person
• An organised framework to guide assessing the ill or injured person, (e.g., ABC) may help learners to be thorough, and prioritise the care that may be required. (See Assess the person resource.)
• Emphasise that the environment may evolve, both quickly and slowly. For example, tensions may suddenly escalate, or weather patterns may begin to shift over time. As well, some characteristics of the ill or injured person may not be immediately known, especially if they live with a disability. As a result, first aid providers should continue to remain attentive to their environment and the ill or injured person, changing their approach with the situation.
• Even though a first aid provider may not be able to access an ill or injured person in an unsafe environment, first aid providers should consider creative solutions. For example, the first aid provider may be able to verbally coach the ill or injured person in assessing and caring for themselves from a distance.
Access help
• All first aid education should include identifying the types of help and resources they can draw on, how to access them, as well as help learners to determine whether to first access help or provide care, depending on the situation. (See Access help resource.)
• Emphasise to learners in contexts with an active EMS phone system in place that they can access help as soon as they suspect they need it. This may help give them confidence in their actions.
• Help learners understand the community resources they can draw on for help. This could include neighbours or bystanders, or the environment (shelter, water, etc). Bystanders, for example, can be asked to control a crowd, to protect the dignity of the ill or injured by forming a barrier, to create shade over or block cold wind or rain with a tarp (sheet), go to the nearest phone to call for help, or to get equipment such as a defibrillator.
Multiple casualty incident
• Simulations are an educational tool that may be used to develop critical-thinking skills, awareness and preparedness for a multiple casualty incident among first aid providers and healthcare professionals.
• Highlight to learners that a multiple casualty incident is an event that results in multiple injured people, outnumbering and overwhelming emergency medical services. This situation includes road traffic collisions, terror attacks, multiple shootings and disasters.
• If possible, include professional responders, healthcare workers, Red Cross Red Crescent volunteers, civil organisations and other appropriate groups in the exercise. Doing so will help people to understand each other’s function and role before an actual event.
• Run simulations on-site or using virtual reality.
• Empower learners by removing any barriers to action and have them practise using the equipment they might have close at hand (e.g., clothing to control bleeding).
• Explain the process of triage and prepare learners to manage onlookers.
Facilitation tools
• Use role-play to practise developing confidence in assessing the scene, moving people and asking others to help. Roleplay can also be useful to practise the process of calling for help, such as the type of questions they may be asked.
• A memory tool may be used to help learners remember the important things to do when assessing a person. ABC is a common tool used. (See Assess the person resource.)