How to Safely and Effectively Respond To Emergencies Involving Human Casualties
Background – Are We Prepared for the Next Disaster?
Emergency preparedness has never been more relevant. In the last year COVID19 has taken the world by storm. Sadly, we were ill prepared on an international, national, local, and even personal level. Luckily, on the spectrum of possible global emergencies, the SARs CoV-2 virus (COVID19) is actually fairly benign. The data is a moving target, but hospitalization and mortality (death) rates will likely settle well under 5% and 1% respectively.
Imagine a pandemic that kills 20% of people though. Or imagine a mega volcano eruption, solar flare, or asteroid impact that could threaten the very survival of our species. Humanity will almost certainly be confronted with disasters far more devastating than COVID19 in the future. I view this current pandemic as an alarm bell. It is telling us to learn from our mistakes, improve our preparedness, and get ready for much greater challenges. While governments will have a large role, preparedness actually begins with every single one of us.
Preparation Requires Thinking, Building Response Algorithms, Gathering Supplies, and Training
The key to preparedness is thinking through possible emergency scenarios, planning ahead, gathering necessary supplies, training, and then periodically revisiting scenarios to keep them fresh on the mind. Simulation is an invaluable tool for preparedness, and greatly underutilized. Things are always easier if we have been through them before. This becomes painfully obvious when you are responding to an emergency you have never thought about or delt with…trust me.
In the hospital, I respond to Code Blue’s all the time. These occur when a patient is literally dying. To prepare, I simulate code scenarios with my medical teams and constantly run through potential situations in my head during down time at the hospital. Additionally, I also carry around cheat sheets with me containing treatment algorithms, vital drug, and electricity doses (to deliver shocks to restart the heart).
Every time I respond to a Code Blue, I have a plan! Anytime you respond to an emergency, you should have a plan too. This plan starts with an algorithm.
The Initial Assessment
Whether you are the first person on scene at an automobile accident, come across an injured person on a remote mountain, or see a co-worker collapse on the job, you should be prepared. Luckily all of these scenarios, as well as every other emergency involving human casualties, can be safely and effectively addressed utilizing what is called an initial assessment.
The purpose of the initial assessment is 3-fold.
1. The first and most important goal is always the safety of the responder. If you are injured, incapacitated, or even killed as a result of your rescue attempt, emergency medical services now have an extra body to handle. If you cannot safely help, you should not help at all.
2. The next goal is the early activation of additional resources. This is often accomplished by dialing 911 (or another emergency number). Any individual responder will usually have severely limited resources. So, your first move will usually be calling for help.
3. The last goal of the initial assessment is to take action against immediate life threats to the person you are trying to help (patient/casualty). Opening an airway, starting chest compressions, and stopping a bleed can buy people time and has saved many lives!
The best way to be prepared is to have an algorithm which you understand and have practiced using. Having your algorithm with you in your car, backpack, or first aid kit, and using it in real time is highly encouraged. Following such an algorithm takes the chaos out of a rescue and prevents important things from being missed.
There are numerous algorithms for performing an initial assessment. Emergency medical technicians, paramedics, military personnel, and search and rescue may all follow slightly different protocols based on things like historical training and likelihood of certain injuries or illnesses. For example, gunshot wounds cause a lot of bleeding. This is why stopping bleeding with direct pressure and early application of a tourniquet is at the top of the military’s initial assessment.
SAD LAB CATS Acronym for the Initial Assessment
Below is the initial assessment which I use when I teach Wilderness First Aid and First Responder courses at my clinic in Boise, Idaho, Wander Medicine. I recommend utilizing the below acronym, SAD LAB CATS, or another which you are familiar with and have practiced.
Before you even approach the scene, observe it from a safe distance, and follow the below steps:
S Scene safety
(can I safely enter the scene? If not wait!)
A Additional resources/Number of patients
(Can I handle the situation, or do I need help? How many people are injured? Consider calling for help now)
D Disease prevention/Body substance isolation
(Protect yourself from infections carried by other people. Always wear medical gloves when touching patients and especially body fluids. A mask can also be helpful. Put your mask in your first aid kit when this pandemic is over. Do not forget eye protection as well)
After you have established a safe scene, called for help, and protected yourself from infection, now it is time to assess the patient/casualty.
L Level of Consciousness
(Introduce yourself and ask the patient if they are ok. Is the patient alert and oriented? Do they respond to you with words? Do they respond to pain [sternal rub]? Or are they completely unresponsive?)
(If the patient is unresponsive, make sure their airway is open. Tilting the head back and Lifting the chin is a good way to do this. If something is in their mouth and compromising breathing, try and remove it. If the patient is vomiting, turn them on their side to prevent aspiration.)
(Is the patient breathing? Do they have a pulse? Check for breathing and a pulse for 10 seconds. If absent, start chest compressions. Compression only CPR is acceptable. However, if breathing and circulation are absent due to drowning, rescue breaths must also be performed. Basic Life Support classes are a good place to learn these skills.)
A Arterial Bleeds
(Look for any active bleeding. Apply direct pressure to stop bleeding. If this does not work, try a pressure wrap or tourniquet)
(Injured or sick individuals can become very cold or very hot rapidly. Take steps to
Protect such individuals from exposure. Remove yourself and if possible, the patient from any dangerous or uncontrolled environments as soon as possible.)
(If concern exists for a spinal or head injury, take great caution regarding any manipulation of the neck or spine, to prevent spinal cord injury. Try and gently place the patient back into an anatomically correct alignment. However, if this is met with pain stop. Be gentle with trauma patients to avoid any additional injury and facilitate comfort.)
Constantly Reassess the Scene, Plan for Next Steps, and Take Care of Yourself
After you have gained control of the scene and stabilized any patients using the above algorithm, resurvey the scene. Is it still safe? Has extra help arrived? Take a moment for self-care. Hydrate yourself and adjust clothing if needed.
If you are in a wilderness environment, it might be some time before help arrives. Make a plan for changing conditions like rain or night fall. The next step in care after the initial assessment requires a detailed physical exam and a medical/personal history. However, do not let these steps delay transport to definitive care.
If you would like to take this knowledge a step further, I strongly suggest pursuing additional training! There is so much more to say, even just regarding the initial assessment. This blog represents a starting point. Additional training is required in order to become an effective first responder.
Constant Reflection is the Key to Improving Outcomes in Emergency Response
The final part of disaster response is reflection. Anyone that responds to emergencies, takes care of patients, or even creates response plans behind a desk should constantly reflect. Ask yourself what went well, what could have been done better, and what steps are needed in the future to improve outcomes. Disasters never go as planned and responses can always be improved.
Sadly, it seems like no-one in government, at least in the United States, seems to be willing to admit that mistakes were made, and things could have been done better with regard to the COVID19 pandemic. To me, this lack of self-reflection on a national level is alarming! Reflection and constant improvement are the keys to success in disaster response! Bigger challenges and more costly disasters are surely in our future. How we prepare today will matter tremendously tomorrow.
Check out FullScope.org for this content in Podcast Form
This content is also covered in a podcast available at FullScope.org. Thank you so much for reading and remember SAD LAB CATS!
Check out Global Rescue's blog to see the original article regarding this content linked here.
Thanks for reading!
Bill Brandenburg, MD
Founder of Wander Medicine Clinic
References I have learned so much about this topic through wilderness first aid/responder courses, my emergency medical technician training and work, advanced wilderness life support, as well as my work in the hospital setting. I have read numerous sources including but not limited to The American Red Cross Wilderness and Remote First Aid Handbook, Auerbach's Wilderness Medicine, Wilkerson's Medicine for Mountaineering, Prehospital Care textbook through St. Louis Community College, and so many other books on the subject I have read throughout the years. However, most of this information comes from personal experience.