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Crisis Response Journal Crisis Response Journal

Helping bystanders to respond in medical emergencies

Posted on 13th October 2016 at 11:47am

In the United States today there is no response time standard for ambulances. Normal responses can take from mere minutes to an hour or more depending on the location of the incident. In addition, mass casualty incidents and large-scale disasters affect the ability of formal emergency responders to arrive and begin delivering care quickly.

Internationally, response times vary greatly depending on the level of medical infrastructure development. In the UK, the National Health Service (NHS) has set the goal of reaching 75 per cent of life-threatening emergencies in eight minutes or less, but rural communities and even busy municipal systems struggle to meet this standard consistently.

Another option coming to market is the Mobilize Rescue System, which offers a truly interactive experience that allows an untrained rescuer to provide appropriate, assessment-based interventions in an emergency

With response times for trained responders increasing, and modern research repeatedly highlighting the critical need for prompt haemorrhage control and airway management, the spotlight is being focused on the need for bystanders to take action. The Hartford Consensus III, a US-based joint committee designated to create policy to improve survival rates from intentional mass-casualty and active shooter events, describes the importance of the role that ‘immediate responders’ should play in an emergency: “Immediate responders contribute to a victim’s survival by performing critical external haemorrhage control at the point of wounding and prior to the arrival of traditional first responders” (click here for more info).

To achieve this, immediate responders need training and access to medical supplies and, since the Hartford III recommendations, a number of models have emerged that are designed to empower bystanders to take action before the professional responders arrive on the scene. Traditional first aid training has been available for decades through organisations like the American Heart Association, the Red Cross and their international counterparts. While enrolling in courses like these demonstrates a desire to help on the part of a would-be immediate responder, the inability to retain this knowledge has been well documented (Yang, Chih-Wei et al. A systematic review of retention of adult advanced life support knowledge and skills in healthcare providers. Resuscitation, Volume 83, Issue 9, 1055 – 1060).

Simplifications of the traditional first aid class are becoming available. First Care Provider takes the concepts of Tactical Combat Casualty Care (TCCC) and its civilian counterpart, Tactical Emergency Casualty Care (TECC), and distils them into a course that is easily assimilated by the general population, even with no prior medical training. First Care Provider focuses on the recognition and management of the most treatable preventable causes of death: Massive haemorrhage; airway compromise; and respiratory compromise. While simplified and focused, the training still requires the bystander to remember what they have been taught weeks, months or years after they received their training.

In lieu of a formal training course, a collection of real-time training aids has become available, most of which provide some type of audio prompting.

Intelligent First Aid is offering a first aid kit that includes ‘talking cards’. The rescuer will need to choose the right card – bleeding for example – and listen to the instructions that are read aloud.

Another audio-based option is the First Voice Emergency Instruction Device (EID) pictured below. This allows the rescuer to select the type of emergency then listen to management instructions that are simultaneously displayed on a small LCD screen.

While both of these aids are an improvement on a traditional first aid kit, neither account for the background noise surrounding most emergencies, nor do they include modern bleeding control tools. Furthermore, both rely on the rescuer to identify and select the correct emergency.

Another option coming to market is the Mobilize Rescue System, which offers a truly interactive experience that allows an untrained rescuer to provide appropriate, assessment-based interventions. Mobilize Rescue Systems integrate the inventory of a modern first aid kit, including TCCC/TECC compliant items like haemostatic gauze, tourniquets and chest seals, with a custom-designed application running on a touchscreen device included in the kit.

Through a series of interactions with the screen, the rescuer can identify life threats, locate the appropriate item of medical equipment and receive just-in-time training on the use of that kit. In testing, it took less than 15 seconds for rescuers to open the kit, determine they had a wound requiring a tourniquet, and locate the instructions to apply the tourniquet.

While managing preventable causes of death like massive haemorrhage and airway compromise are critical, Mobilize Rescue Systems also offer untrained rescuers the ability to assess and manage more common emergencies like allergic reactions, seizures and cardiac events. The application helps a rescuer identify possible anaphylaxis or cardiac-related chest pain, find indicated, over-the-counter medications (diphenhydramine or aspirin) and provide proper doses of those medications to the victim.

Mobilize Rescue Systems offers three options: A comprehensive kit designed to hang on a wall bracket near an AED (need to put this in full before initialising); a mobile kit that offers the same treatment capabilities of the comprehensive kit in a backpack weighing under 10 pounds; and a compact kit, which is an individual first aid kit (IFAK), which makes use of a phone app that provides life threat management only.

The ability of a first aid kit not only to organise medical supplies, but also to help the rescuer choose and use the right piece of medical equipment correctly is a new concept, far beyond anything that Robert Wood Johnson envisioned in 1888 when he began marketing the first aid kit to the railroads. Modern technology affords the medical community the opportunity to create effective, real-time training systems that vastly improve the ability of a willing, but untrained bystander to intervene when minutes or seconds count.

By Seth Goldstein

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