Confusion marks most emergencies. Training and rehearsal is the best remedy but some easy-to-remember tips can come in handy as well.
The A, B and C system of first-aid is an easy way to remember and sticks in the mind because of the obvious allusion to the alphabet. ‘A’ stands for airways, ‘B’ for breathing and ‘C’ for circulation. These 3 aspects of a victim’s physical state can often be adequate to maintain life in a steady state until professional medical help is available. It is common for the tongue or some sputum or vomit to block the airways and cause death by asphyxiation or choking. This is common when a person is unconscious. The first step in first-aid should be to check whether or not a person is breathing normally. The rhythmic rise and fall of the chest, exhalation of air from the nostrils or mouth and pulse at the neck or wrist are common and quick ways of knowing whether or not a person is breathing. The mouth should be prized open, placed on one side and the mouth physically inspected and cleared of any visible obstruction. It may be necessary to grasp a person from behind with both hands below the rib cage and give a series of quick and sharp jerks to dislodge any particle that may obstruct the passage from the back of the throat to the lungs. Keeping the airways free of obstruction is the A or first step in attending to an emergency victim. Drowning is a common example in which airways are blocked.
B stands for breathing and if the methods described above indicate that the victim has stopped breathing, and then in such a case sharp blows on the chest near the heart should alternate forcible exhalation of air into the victim’s mouth while the nostrils are kept closed. The heart should be checked after every few cycles and every attempt to get the breathing process restarted.
C stands for circulation and the focus should be to stem bleeding and loss of blood. The best way to achieve this is to hold the bleeding part in an alignment against gravity, to physically try and reduce if not stop the outflow of blood. A tourniquet upstream of a ruptured blood vessel is generally most effective. A tourniquet also helps a victim of snake or scorpion bite. A dog that has bitten a person should be impounded for observation or the owner identified and tracked, so that a possible development of rabies can be monitored.
It is relatively easy to keep a patient alive and stable until medical help is at hand if A, B and C are under control. Triage should be deployed to attend to the critically wounded in priority over the dead and those with minor injuries. It always helps to enlist volunteers to call for help, to control bystanders and to restore calm as quickly as possible. Safety lights, matches, torches, dressings or clothing, blankets, infection control agents, potable drinking water and cell phones are some emergency items that will also be put to good use if offered or available. Victims should be reassured and kept as quiet and still as possible. The spinal cord may be permanently damaged if a victim moves or is moved without a medical examination and immobilization. Water should be used liberally on all burns and dermal exposure to hazardous chemicals. Clothing removed by cutting if off rapidly if large sections of skin have been lost. A victim’s identity and emergency contacts should be ascertained if possible while he or she is still conscious. Ingested poisons may be removed by inducing vomiting with either a salt solution or by using an inserted finger at the back of the throat. However this should not be attempted on an unconscious patient.
Doctors and related experts can train volunteers to conduct triage and to deal with emergencies of all kinds. Dummies can be used for practice. Periodic refreshers help people remember the important points and to render effective and life-saving first aid when the occasion arises. The blood group, emergency contact numbers and known allergies should be recorded and widely known to identify emergency aid volunteers in a community, as this information can help hospitals and doctors save time in managing critical cases. Weekends, night and holidays are notorious for emergencies. Volunteers should share the watch and remain available near telephones and shelters by rotation, so that trained help is always on hand. These volunteers should ‘case the joint’ so that they can reach the site of an accident in a jiffy. Outlying areas should be in satellite contact with hospital casualties and relief centers so that they can ‘talk’ local people in to taking appropriate steps until help arrives. Modern technology if properly deployed can make emergency relief quicker and more effective than was possible before.
There are lessons in each emergency no matter where it takes place. All accidents should be audited and the ones that occur in distant places should be studied through reports that come through over time. Volunteers should study the chain of events and use hind-sight to plan new and additional preventive and contingent measures. There is a learning curve to be traversed in emergency management and people need not wait for the worst to happen in their communities before planning response systems. HAZOP (Hazard and Operability Studies), (HACCP) Hazard and Critical Control Points, ‘What if’ scenario building and Problem Analysis are some of the advanced techniques available for systematic Risk Management. ISO 14000 is another system that improves safety and makes it easy to respond in proper sequence during an emergency. Retired Military personnel, especially from the Medical Corps are the best people to lead volunteer efforts for disaster recovery templates. All volunteers should work in close association and under the leadership of the local Police and Fire Brigade to avoid duplication and resultant confusion. This is a major benefit of compulsory Military Service in Switzerland, where every citizen is equipped and trained to respond in coordinated and appropriate manner to an emergency-though they almost never have one!