What to do at an emergency before the emergency personnel arrive?
July 7, 2005 4:39 AM   Subscribe

A question for all police, medical, fire, or other emergency professionals: what rules of thumb should everybody know in case they are present at a terrorist attack or other emergency?

I'm watching news coverage of the explosions here in London, and it occurred to me that if (for example) I was evacuating an underground train, and I saw somebody lying unconscious, I wouldn't know whether I should carry them with me (to prevent them from suffering smoke inhalation) or leave them there (to avoid injuring them further by moving them.) Or if I was first at the scene of an car crash, I wouldn't know how to help any victims while waiting for the ambulance to arrive. For that matter, never having been in such a situation, I'm not even sure which dilemmas I should be asking about... I have no medical training, so the simpler and more concrete you can make your advice, the better.
posted by yankeefog to Health & Fitness (14 answers total) 2 users marked this as a favorite
There are more rules to know than will fit on a thumb, and attempts to apply the wrong rules could (as you hint) hurt somebody. If you want to feel competent in this kind of situation, you can't beat a proper first-aid course.
posted by flabdablet at 4:51 AM on July 7, 2005

I have a good tip if you find yourself in a moving mob and fear of being crushed:

* put hands in armpits, and "spead wings"
* kick your knees as far up to your chin as possible.

This will make you move /faster/ than the flow of people, and the "spread wing" formation ensures you have air access.
If you're a petite person, your feet won't touch the ground. That's normal.
If you're heading towards a wall, brace feet for impact and kinda bounce yourself off the wall and /above/ those who crush.

The important thing here is to keep /above/ the crowd.
posted by ruelle at 5:17 AM on July 7, 2005

Another tip I remembered:

If you make a tourniquet to stop a limb bleeding, make SURE you check at what EXACT time you did it. Write it down on the skin or something.

Why: toxins build up in the limb that's blocked off, so even if anyone can make a tourniquet, not everyone should take a tourniquet off, because then the toxins will travel to other parts of the body and will eventually kill the person.

(note: IANAD)
posted by ruelle at 5:28 AM on July 7, 2005


The first rule of thumb is to not get anyone else hurt. If debris is raining down you don't want to get in the way of it while helping someone. This will only make things harder when the real EMTs get there, they'll have to help two people instead of just one.

Also, blood is considered a hazardous material and universal precautions should be used. It doesn't hurt to carry a small first aid kit with a couple pairs of latex gloves.

As for moving people: If they're in danger, such as in a burning car, you should probably move them. Injured is usually better than dead. A good wilderness first aid class (or maybe others, I dunno) will teach you how to do this without injuring them further. Wilderness first aid classes generally teach you to deal with injuries with the assumption that help will not arrive any time soon, like might happen in a large scale attack.

It's also good practice to document anything you do, both for the EMTs when they arrive or for any investigations after the fact.

Most states in the US have good Samaritan laws that will protect you, but it's always possible that the person you pulled from a burning train will sue you for breaking their ribs while extracting them. This sucks, and may not be a factor for you in a crisis, but you might want to brush up on the laws.

As flabdablet said, the best thing to do is to take a good first aid/first responder class. Doing so will make you much more confident in your abilities to deal with such situations.
posted by bondcliff at 5:50 AM on July 7, 2005

Always know where the exits are. You should get in the habit of doing this wherever you go so that it becomes instinctive. Carry a small, reliable flashlight, and a tool like a leatherman in your bag or on your person if possible.
posted by mlis at 7:32 AM on July 7, 2005

bondcliff writes "As for moving people: If they're in danger, such as in a burning car, you should probably move them."
Amen to that.

It's not really possible to give advice in a general manner for injured people. If there's no immediate danger, keep them warm, don't move them, get an ambulance. Talk to them. Reassure them. Comfort them. Stay with them.

A little bit of bleeding - don't worry about. More than a little bit, apply pressure to the wound, even with your bare hand(s) if necessary, if fears from blood aren't too overpowering - but better to rip up your clothes and apply as a compress.

If there is immediate danger -- car burning, bridge collapse etc etc -- just do your best to swiftly move the person to a point of safety. Getting them out of the way of danger promptly is more important than overly worrying about keeping a fractured limb or injured neck straight. Injured, even more injured is better than dead.

As suggested do yourself and others a favour, go do a first aid course.

Don't panic or yell if possible during a confusing event involving bombs/crowds - just freaks everybody out or at least moreso (easy to say of course).

Trite but: in a disaster make a friend/partner, if circumstances allow - in times of adversity I can well imagine that a team will do better than a person on their own.

Make it a habit to note where the exits are when you enter a building.
posted by peacay at 7:33 AM on July 7, 2005

If it's a fire or a chemical or biological attack: get outside as soon as you can. The solution is dilution. Your best routes are typically the fire routes.

Don't linger. Your responsibility is to get out, aiding others as necessary, but to evacuate. Be calm, and try to keep others calm.

Don't try to "rescue" people if there is any risk to you. I've got a fair bit of fire, confined space entry and hazardous site entry training, and the thing that they all emphasize is Be Safe First. The sad truth is that a common cause of accidental death is attempting to aid someone else who is already down. Never enter a confined area (room, train car, even an empty swimming pool) if the people inside are down. The hazard may not always be visible. Get help, don't attempt rescue yourself. Heros just make extra victims for the firefighters to retrieve.

If you don't know first aid, your best option is to take the St. John's Ambulance or Red Cross courses. If you do, take the full aid + CPR course. It's specifically geared to "what do I do before the ambulance arrives?" scenarios. Every one should know how to do CPR and run a defibrillator.

Half-trained first aid can be dangerous to the "patient" and leave you open to legal problems later, particularly in the States. Taking either course in Canada specifically lets you out of any liability for any aid you offer. It's true that injured is better than dead, but you don't want to paralyze someone because you dragged them out of a car either.

In short, get out of confined areas. Follow instructions if they're offered, in a subway, for example. Try to stay calm. Offer aid only if it doesn't endanger you. Be aware that all hazards may not be visible. Get First Aid training.
posted by bonehead at 9:15 AM on July 7, 2005

First rule of thumb: In military first aid, the very first step is always to be sure that the area is safe to begin with. It makes no sense losing two people instead of one.

Second rule of thumb (should really be first but wanted to answer your question first): Like others above have said, know what your exit strategy is at all times.

Third rule of thumb: The final piece general advice I can suggest is to ensure that in the home and in the car (maybe even in your desk at work) keep a bug out kit. That is to say, a kit that can help you survive the next 8, 24, 72 hours (how long a kit lasts, and where you keep them is up to you). There's plenty of sites that can go into the details, but the basic concept is that each kit has enough to make you survive a disaster for a certain period of time, so an 8 hour kit might have a bottle of water, candy bars, a small 1st aid kit, a flashlight, a knife and one of those mylar blankets, while the 24 hour kit (which usually complements the smaller kit) would have duct tape, blankets, several thousand calories worth of food, a radio, etc... while the 72hr kit might have a stove, fuel, a large supply of water and food, a large first aid kit, a supply of money, clothing, solar charger, flars, axe, etc... Usually the small kit can be in a small box, the medium kit can be in a backpack, and the large kit in the basement or trunk of the car (or both).

Also, I strongly suggest putting an excellent 1st aid book in the medium kit, and a survival guide in the large kit.
posted by furtive at 10:02 AM on July 7, 2005

Excellent answers everyone. I just wanted to stress Be Safe First. Take a first-aid/CPR (or first responder if you're motivated enough) course so you can learn what constitutes "Dangerous Enough to Move" or "Leave Them Alone". Your primary responsibility in a widespread emergency, however, is to yourself.
posted by muddgirl at 10:22 AM on July 7, 2005

Always know where the exits are.

There is a key piece of info right there. Next time you are on the tube, actually read the sign about what to do in case of emergence. You won't be able to in the dark.

In a hotel or tall building note the exit stairs, just note them, its not like you have to walk them, just consciously notice the signs.

For me carrying a leatherman is not possible, I'm in and out of secured buildings all the time and only my own office can I carry anything sharper than keys.

Here's a scary one, but we were all recently reissued iodine tablets to keep for a "rainy day" I know they are available over the counter on-line, maybe they'd be worth a look if you live in a place like DC, NY, London, Paris, etc. Or don't, don't go overboard.
posted by Pollomacho at 11:44 AM on July 7, 2005

Here's what DHS recommends of its employees (remember folks, its July):

During this heightened state of alert, you might want to have your own “GO” kit near your desk. This kit could include bottled water, a flashlight, a small portable radio, sneakers, or other comfortable shoes; and, if appropriate, extra gloves, and other items to keep you warm should you have to remain outside of the building for any length of time.
posted by Pollomacho at 12:19 PM on July 7, 2005

The things I've been taught have mostly already been covered. Remove people from immediate harm (fire, dense smoke, unstable buildings); otherwise, don't move them, especially if there's a chance their spine could've been injured. A fractured vertebra is easily converted into a permanent spinal cord transection by a well-meaning attempt to move the injured person, and this can mean instant death or permanent paralysis that could have been avoided.

Don't try to aid the dead or the about-to-be-dead. Instead, leave that area.
posted by ikkyu2 at 4:41 PM on July 7, 2005

One of the best bits of advice I've ever seen is not to make general requests or demands. Don't yell Somebody dial 9-1-1. People might, or they might dither or argue amongst themselves. Point directly at one person and say You! Call 9-1-1 and have them send an ambulance.
posted by dhartung at 7:53 PM on July 7, 2005

Response by poster: Thanks for the advice, everybody. I'll sign up for a first-aid course, and I'll make a mental note of the other advice. I really appreciate it. Needless to say I hope I'll never need to use this knowledge, but it helps in having a sense of control (and of course a first aid course will help even more--that's an excellent idea.)
posted by yankeefog at 10:55 AM on July 10, 2005

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