Dealing With a Triage Situation as a First Aider …

Time spent in the outdoors can lead to a situation where there are many casualties and you as a first-aider need to work out a prioritised plan of how best to manage this situation. As a first-aider you will need to work swiftly through a series of actions and as ever you will be guided by the framework of your accident procedure (the ABCs).

  1. Assess the situation – is it safe?

If it’s not safe to be there – either do something to make it safe or get away. Either way don’t make yourself a casualty: you’ll be no good to anyone.

  1. Airways

Before you even call 999 quickly sweep through all the casualties and roll anyone that is unconscious on their side. Don’t worry about other injuries or how you do this – just get them on their sides so that they have stable open draining airways. Doing just this gives them every opportunity to breathe. If there are people available to do this, order them to do likewise.

  1. Phone for help

If nobody has yet called the emergency services you should do so now. (Chances are – they have).

  1. Shock management

Now turn your attention to dealing with blood loss. Anyone that is able to help you, tell them to find any bleeding casualties and to apply pressure to the wounds with anything they can find. Since the 2015 European Resuscitation Council’s guidelines were published, tourniquets have also been brought back into first aid 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. 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. (The wider it os the less painful it will be). As a first-aider or good samaritan, and applying an improvised tourniquet, there is a good chance that you will be anxious and in a panic. To be sure to get the desired result as soon as possible, tie the tourniquet 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. Only if you have the training/confidence to do so, try tying a second tourniquet about 5cm above the wound site. 15 minutes after the first (upper) tourniquet was applied, you can start to loosen this off slowly. If the wound starts to bleed again, reapply the tension in the upper tourniquet. If the lower tourniquet on the distal limb holds however, remove the upper tourniquet.

Keep these casualties warm and reassure them that everything will be ok. Keep people conscious: conscious people stay warmer for longer!

  1. Managing the walking injured and people in panic

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 that provide shelter, like a stone wall are ideal. Start treating people for hypothermia. Offer lots of reassurance!

  1. 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.