People will take almost any measure necessary to help one another, even in dangerous and unthinkable circumstances like we saw during the tragedy in Las Vegas. Confronted with horrific circumstances, everyday people rose to the occasion and made a difference.
As a company that exists to empower bystanders to save lives, we want to do everything we can to make sure willing care providers know some best practices for good, critical decision making during emergencies - in order to stay safe themselves while administering life-saving care.
Situational awareness will help keep you safe while you administer care
You use situational awareness every single day. Recognizing the speed of an approaching vehicle as a threat before you step off the curb to cross the street, being aware of all of the exits from the room you're in, or noticing the front end clerk about to open a new lane at the grocery store moments before anyone else can step in line. You do not need a tingling 'Spidey sense' to be aware of your environment and to anticipate changes within it. Good situational awareness involves maintaining a focused, global perspective on what is occurring around you while filtering out external distractions. There is nothing clairvoyant about it. Like any other skill, it gets easier with practice.
In the case of an act of violence, or any other emergency, good situational awareness can mean the difference between escaping unscathed or not. Knowing the Phases of Care can help you provide care, safely.
What are the the phases of care?
Phases of Care is the term used by the CoTECC (The Committee on Tactical Emergency Casualty Care) to rank different levels of danger (or threat) in any given moment. For civilian responders, trained or untrained, the levels are simply referred to as Hot, Warm, and Cold.
- Hot Zone (Direct Threat)
- Warm Zone (Indirect Threat)
- Cold Zone (Evacuation Care)
The 'Cold Zone' - Evacuation Care
Most of us live our lives in the Cold Zone. It's fairly safe, most of the time. We are able to make decisions without considering the factor of imminent violence. In the context of an emergency, a 'Cold Zone' is a place where it is safe to provide care, wherever the victim happens to be located. For a vast majority of the emergencies, this is the Phase of Care encountered - chest pain in a suburban home, a broken ankle on a playground, or seizure in an office for example. The hard part is preventing ourselves from being lulled into complacency - the 'heat' of a place can change unpredictably and without warning! It is your situational awareness that must alert you to any changes in the environment that may impact your decisions and actions. Professional rescuers and responders refer to this as 'Evacuation Care' because it is the kind of care they provide after a rescue from a dangerous place is complete.
The 'Warm Zone' - Indirect Threat
The Warm Zone is where there is an increased likelihood for bad things to happen. The scene of a violent attack or a car accident could both be considered a 'Warm Zone' or an Indirect Threat environment. If someone was just attacked, do we know for sure where the assailant has fled, or who they are exactly? Are we sure that he/she isn't returning? If an accident has just occurred on a suburban roadway, traffic will be snarled as onlookers attempt to catch a glimpse, are they paying attention to the bystanders beginning to provide care?
As a rescuer begins to make decisions about how to intervene in a Warm Zone, they again will rely on their situational awareness to inform their choices. Providing care in the Warm Zone is a constant Risk vs. Benefit analysis: "Is my personal risk worth the potential outcome for others?" Unfortunately, there's no way to answer this question from the comfort of our arm chairs. This decision can only be made by the individual in that moment. It must be remembered that creating another victim in the scenario by taking unnecessary risks complicates the problem. This is certainly not to say that some risk isn't worth the eventual reward of intervening to save a life, it simply has to be a considered decision based on an evaluation of the circumstances at hand.
Professional responders call this an Indirect Threat Care because it's providing care in a place where there could be a threat, it's just not imminent.
The 'Hot Zone' - Direct Threat
The Hot Zone is a little more clearly defined - A Direct Threat is a direct threat. The threat is still present and you are in imminent danger. For the concert goers in Las Vegas, until the threat was neutralized by law enforcement or they were able to find solid cover (not concealment), they were in a direct threat environment. If you are involved in, or stop to assist at, a motor vehicle crash on a highway where traffic continues to speed by, you are in a direct threat environment. If you are walking down the sidewalk and construction debris clobbers the person in front of you, you are in a direct threat environment. What does the increased threat level mean for someone wanting to render aid? Are we paralyzed by the imminent threat...maybe, but not necessarily.
Professional responders call this Direct Threat Care, and the care is extremely limited, because the imminent threat poses a greater risk to the victim(s) and responder(s) than the injuries and illnesses already present.
What care is safe to provide?
Before providing care, you have to decide what the threat level you are dealing with. If you jump into providing care before assessing the situation, you can get hurt - and hurt the chances of saving a life.
What care can be administered in the Cold Zone?
In the 'Cold Zone,' care can be rendered freely. Use situational awareness to stay alert, but the situation doesn't dictate a delay in providing aid. Stop bleeding, use hemostatic agents, apply pressure dressings, seal chest wounds, place folks in the recovery position, begin CPR, etc.
What care can be administered in the Warm Zone?
If the situation feels 'warmer,' and you either find yourself in an Indirect Threat or, the 'Cold Zone' heats up, interventions should be focused only on bleeding control and airway management. While still serious, chest wounds, burns, fractures and other injuries take longer to become life or limb threatening. If immediate life threats can't be managed quickly, efforts should be made to either move to, or create, a safer environment from which to operate. Ask yourself questions like, Can we close doors? What if we move farther down the shoulder of the road? Can that truck driver park there to block the lane? Can we evacuate through this emergency exit and hide behind that retaining wall?'
Stop massive bleeding and find or create a safer place to offer more care. Focusing on more involved interventions in this phase of care impairs our situational awareness and may result in a missed opportunity to evacuate or missing the transition to a Direct Threat.
What care can be administered in the Hot Zone?Rescuers and unarmed responders, like most Fire/EMS resources, should not knowingly place themselves in a Direct Threat environment. The reason we discuss it here is because sometimes the Direct Threat environment finds us. No one in Las Vegas expected the 'Cold Zone' of the Vegas Strip to heat up so violently, just like no one expects construction debris to rain down on them on the sidewalk. However, when faced with a spontaneous direct threat, our situational awareness must go into overdrive so that our choices may be informed.
Your safety is paramount in the Direct Threat environment. If you are a person that intends to render care to those in need, you're helpfulness is significantly hampered if you become another victim. Once the direct threat is identified, getting away, finding cover or at least finding concealment are the top priorities. If you are capable, and the situation lends itself, taking as many other victims with you also reduces their threat. If they can move on their own, direct them to a safer position, if you can safely move them, take them with you to a place of refuge. Even if the relative safety is incrementally better, you're still tipping the scale in your favor.
Once your situational awareness informs you that it's safe enough to start offering care, get to work! Stop the bleeding, open the airways, seal the chest wounds and keep your victims warm!