First aid given under disaster circumstances is somewhat different than first aid given under regular circumstances. In normal instances when a person is severely injured, first aid is simple medical care given to keep the person alive until the professional 911 rescuers such as paramedics or EMT’s can arrive to take over. But in a large-scale disaster it is not expected that 911 emergency services will be responding to the general public for between 3 days and 2 weeks. Consequently, what is called for will be somewhat different.
In our neighborhood large numbers of people have been trained in CERT or NEST. This is emergency response training with a disaster orientation. If you are one of these people, this will be a tiny review for you. If you are not and have no disaster response training, this will help you understand what might be going on around you -- and having you understand this is very important. Understanding helps to reduce chaos and confusion, and we will need all the help we can get to do that.
First of all, in a disaster where your neighbors are probably going to be the only ones available to help those who are trapped or injured, it is essential that they follow 2 rules:


       If the rescuers get injured or killed by going into an unsafe situation, they become part of the problem, increasing it, and they are no longer able to help with the solution. They are trained in how to keep themselves safe while doing their best to help others, and they are also trained in how to help others without injuring them further.


       In a disaster, except for people who are so critically injured that they will die no matter what is done, the enormous majority (about 90%) of the rest of the injured people can be saved if someone can make sure 3 simple things are done for them within a fairly short period of time: the ABC’s of disaster first aid:

A -- Clearing the Airway:  if the victim has stopped breathing, their chin is carefully lifted, tilting their head back to clear their airway. This is done twice giving them 2 chances to have their airway cleared -- 2 chances to breathe. If they don’t begin breathing at that point, they are tagged “Dead”, and the rescuer moves on. This may seem harsh because we are not doing Rescue Breathing or CPR, but in a disaster circumstance there would be no point. The person is probably not choking on a piece of gum or meat, but is unconscious due to severe injury. Doing the chin tilt moves the victim’s tongue so that they will be able to breathe unless there are other reasons why they are not breathing. CPR is done until the paramedics arrive, and in this kind of situation, they won’t be coming.

B -- Stopping Bleeding:  If the person is breathing but is severely bleeding, (spurting blood), this must be stopped immediately, of course, before they bleed to death. Almost all bleeding can be stopped by applying direct pressure over the wound. If a clean bandage or cloth is available to put over the wound first, that is best.    If not, a direct hand (hopefully gloved)
will do. As bandages get soaked with blood, more are added on top, not removing the bottom ones.
If direct pressure doesn’t stop the bleeding, pressure can be applied to key pressure points: one on the brachial artery in the upper inner arm for bleeding from the arms or hands, or one on the femoral artery just below the groin line on the upper inner leg for bleeding from the leg or foot. In both these cases, the artery is being pinched against the bone.
If severe bleeding still continues, a tourniquet can be applied, but ONLY AS A LAST RESORT. Applying a tourniquet is a certain decision to have that limb of the person amputated. This should never be done unless the person would otherwise die.

C -- Circulation = Treating for Shock:  When someone is injured badly enough, their body goes into a defensive mode to protect their most vital organs from loss of blood. This cuts down on the circulation to the rest of the body and can lead to death of cells, tissues, entire organs, and ultimately the person. Amazingly, shock can kill someone faster than they can bleed to death, so it is a very serious condition. Shock caused by injury is much more serious than psychological shock, which normally will not kill you. When a person is going into or is in shock, they will have:

       - rapid, shallow breathing;
       - cold, pale, and clammy skin, and
       - an inability to follow simple commands, like, “Squeeze my hand.”

Shock is so easy to treat that it is recommended that you treat all injured victims for it, especially children:

       1) lay the person on their back, preferably on a hard surface
       2) elevate their feet 6-10 inches
       3) keep them warm -- blanket or space blanket
       4) maintain an open airway and control bleeding
       5) avoid rough or excessive handling
       6) do not give them anything to eat or drink

These 3 simple ABC’s will save the majority of lives that can be saved in a disaster; and as you can see, they are so simple, anyone could do them.

       If we had something like an earthquake, families would assemble at the Staging Area, a CERT/NEST team leader would be chosen to organize rescue efforts, search and rescue teams would be sent out to help others, and victims would be brought back to either an immediate care station at the Staging Area, or to a delayed care station.

       If you are not yet CERT or NEST trained, we hope you will become so the next time we offer the training. Everyone’s help will be needed, and this training can bless you and others for the rest of your life.