Triage is the process of sorting casualties in order of priority. Now this in itself sounds simple enough, unfortunately without an understanding of how to do this effectively, objectively and accurately, we have a habit of making these decision based on the wrong criteria: We follow common heuristics such as ‘going for the quiet ones’ or ‘treat unconscious casualties before conscious casualties’. Humans are also genetically hardwired to react to the sight of blood so we triage based on injuries; treating the most visibly traumatic – the blood guts and gore – over less obvious injuries.
Terrorist attacks for the majority of us will remain an atrocity that we will only hear about or see on the news. When there are many casualties we need to apply the principles of triage first aid. Should you ever find yourself as a bystander and survivor, even with absolutely no first aid training, here’s what you can do to be a life-saver.
Is It Safe?
If it isn’t safe for you to be there you need to get away. You must not put your own life at risk. If it is impossible for you to run to safety, you need to act fast and try to find somewhere that you can hide until the danger has passed.
Let Them Breathe
Before you even call 999 (911 if in the US), quickly sweep through all the casualties and roll anyone that is unconscious over on to their side. Forget about any other possible injuries at this point, just roll them on to their sides so that they have stable open draining airways. Doing just this gives them every opportunity to breathe. If there are other passers-by that are able to help, order them to do likewise.
Call Emergency Services
They should have by now, but if nobody has called the emergency services, do so once everybody has been rolled on to their sides. There is a good chance that somebody has already done so by this point.
Now you need to turn your attention to dealing with any blood loss. Take charge and get anyone that is able to help you, tell them to find bleeding casualties and to apply pressure to the wounds with anything that they can find. Tourniquets were originally removed from first aid training but since the 2013 Boston Bombings they have been brought back into training; but only as a last resort. Tourniquets can only be used on limbs and only if the bleeding is so heavy that the casualty is likely to die within the next few minutes. If you have to tie a tourniquet to a casualty you are in effect consigning their lower limb to amputation. It is a choice of life over limb. But for casualties who have already lost a lower limb for example, a tourniquet will be a life-saver.
Tie a tourniquet using anything that you can improvise with. This might be the shirt off your back, the sleeve of a jacket or a spare inner tube from a cyclist. As a first-aider using an improvised tourniquet you will be flapping and in a panic. To be sure to get the desired result as soon as possible, tie it to the upper limb (above the knee or elbow) as tight as you can. Keep tightening until the bleeding stops or you can tighten it no more. If you have the presence of mind to do so, mark the casualty’s face with a T and the time that the tourniquet was applied. Keep it applied: it will only be a medic who should undo this.
The Walking Injured
Sight an obvious landmark that is in a relatively safe space. Anyone that can’t be of assistance should be directed to that place and told to wait there. Obvious land marks like a phone box are ideal – but also try not to block access for the emergency services who are likely to be there soon. Once the emergency services are there find a casualty who is not receiving medical attention and simply talk nicely to them, and reassure them that they will be ok.
Take Care of Yourself
Post traumatic stress disorder (PTSD) is a very real thing. It doesn’t have to be a mass casualty situation – it could just be a near-miss. Different people respond in different ways. If you are involved in a situation such as this remember to take care of yourself. Don’t go through the what ifs – it’s not healthy for you or helpful. Give yourself a pat on the back for getting stuck in and do seek help. You will need it.