In early 2020, a friend reached out to see if I would be willing to help them to get better at recognizing and acting in situations where someone might be hurt, especially with children. I’d never really articulated my understanding before (and I don’t think I’ve ever administered first aid to a kid), but I think sharing this quick draft was probably better than nothing for him and for y’all, so I’m including it here.
Humans are really complicated machines and we face countless threats -- you’ll learn more about what can go wrong over time as you and the people around you have problems. Other than recognizing life-threatening situations where minutes count, I’d recommend practicing googling and building out your models over time, including what resources to trust. e.g.
But basically: we need oxygenated blood moving around our bodies. So you need to keep breathing, keep your heart beating, keep your veins/arteries transporting blood properly, and not lose too much blood.
So learn to notice, check, and troubleshoot those basic problems (I’m literally not googling/referencing at all and I've had very little formal first-aid training, so don’t take this as gospel; take it as a starting point for what best practices to seek out — and maybe take notes and share them as you learn things? 🙂)
- The person isn’t breathing: choking on a thing, allergic reaction, windpipe is collapsed, inhaled water/drowning, etc.
- (when you come upon someone not breathing, you typically put them on their back and tilt their chin up to open the airways as a first effort (maybe swiping for something in the way of their windpipe, depending on the circumstance) and pray they start breathing on their own). For choking, heimlich maneuver is probably still a thing, and before that you can whack them on the back a few times.)
- The person is losing a lot of blood or their heart isn’t pumping it around properly: internal bleeding (e.g. hit by a car), external bleeding (e.g. severed artery) or both (e.g. gunshot wound) and/or their heart has stopped and/or there’s a something preventing blood flow (to the brain=stroke, to the heart=heart attack, to everywhere=sepsis?). Dehydration can also be a factor. Sepsis is a strange case where your body overreacts to an infection and your bloodpressure drops very low, very quickly, which can lead to “shock,” starving your organs.
- (Stop the blood loss: put pressure on the wound and elevate it. If it’s an artery, you’ll want to cut off flow with directed pressure by e.g. pressing on specific points near where your limbs join your body, having someone kneel on it, etc.)
- (If their heart isn’t going, cpr will push at least some oxygenated blood through their heart and brain to prevent those tissues from sustaining as much damage—this is physically demanding and will likely break their ribs, but they now say it’s fine to do with only compressions (in rhythm to the Bee Gees “Stayin’ Alive”). Once you start cpr, the idea is that you do it until the professionals show up to try to restart their heart, so you’ll want them on their way ASAP — also good to be proactive about locating AEDs in the places you frequent (including athletic fields); most should have clear instructions for civilian use.)
- (Capillary refill check is quick and easy, so is recognizing confusion, passing out, extremely fast or slow pulse or breathing, etc.)
Actively build out your models as you go:
Beyond that, different situations call for different know-how, so try to pay attention to the situations you’re in and imagine what might go wrong and what you would do if it did.
I think this is also a way to better retain knowledge: learn it when it’s relevant to you.
During the current civil unrest:
Right now maybe google around and find best current practices on treating people exposed to different irritants: pepper spray/balls, tear gas, the thing that’s like tear gas but that they claim isn’t actually. Notice that it is often useful to understand the way the irritant works and how your body works normally + in response to the irritant to evaluate/understand the treatment options and what you could use to substitute.
Read about concussions (or have Mindy copy-paste all the advice I gave her when she fell down the stairs at the office 🙃).
Read about bleeding: I’ve heard face wounds bleed a ton but aren’t dangerous — but scarring is a relevant thing in this culture. Learn where the important arteries are that you don’t want cut and where to apply pressure. (Note: weirdly, when something has stabbed into you, the stabbing implement is often applying pressure to the wounds it made inside you, so removing it can cause bigger problems.) How to treat bumps and bruises and what can go wrong with an otherwise low-stakes laceration: was it properly cleaned? What are the signs of infection? (wound infection is very common and can be a big problem if near joints or left untreated) Is the person current on their tetanus booster? Could that person’s blood have contaminated someone else with a disease they carry?
Supplies:
Consider what you could add to your first aid kit as you learn things and game out scenarios. (Maybe in most worlds you don’t need serious supplies including blood clotting stuff or things for splinting broken bones because you are close to professionals, but earthquakes or riots or pandemics or relocating might make you reconsider stocking certain things if you can't get to a hospital, or maybe you need additional protection/goggles+mask in a world where you need to treat someone without social distancing).
It’s also just convenient to have a well-stocked medicine cabinet. When you or a loved one gets hurt or gets sick, it’s great to be able to take their temperature and blood pressure (which can help a telehealth appt to be more effective) grab a pre-chilled ice pack, a
Make it a habit:
Next time you’re at a pool or at the ocean, read about what drowning looks like, the dangers in attempting rescue, what to do if someone isn’t breathing because of inhaled water, what to do in the case of rip tides, jellyfish sting, stepping on a sharp piece of coral or a sting ray barb, or fishhook, etc. (Often there will be safety information posted in the places you go, whether it's at the pool or by the beach or in an elevator or an airplane).
Kids:
Once you have a kid, you’ll learn a bunch of kid-specific stuff: (I don’t know how this happens, but once they have kids, people pretty reliably end up having latches on their cupboards that make them annoying to open and they have baby-gates and rubber things on the corners of their coffee tables and they get gun safes and they always have someone watching the pool with undivided attention—so something useful must be happening there).
Kids are kind of their own thing, e.g. adults don't typically drink poisons (other than alcohol :grimacing:) but I hear kids can be idiots about that. Bottles (including things like toothpaste) usually have labels with info on whether to induce vomiting or not, whether to flush eyes out with water, whether to call the poison control center, etc.
Again, you'll get a lot of mileage from paying attention: noticing when an activity has just become dangerous, noticing that your kid's poop is an unusual color, noticing when your kid has been quiet for too long or when there's a new game with objects that your kid could choke on or when your kid seems more rosy cheeked and might be running a fever. Also probably worth understanding dog/kid dangers (I believe a basic model of dog norms makes me significantly less likely to ever sustain a serious bite, but it does require paying attention 🙃).
Note: Toddlers fall all the time and are generally fine (though maybe a good chiropractic adjustment could help on occasion). As they get older, maybe they’ll have a relatively simple break or sprain. Old people fall and it is often a major deal that can signal the beginning of the end.
When you can't google:
If you’re going into the woods where you don’t have reception for googling or calling for help, think about what types of things might go wrong and prepare. The place you’re going might have regional hazard info on their website. Bear country? Wild boar? Poison oak? Snake bite? Severe sunburn or heat exhaustion? Being stuck in your car in a snowstorm: hypothermia or frostbite? Bug bites from a mosquito or tick carrying disease? Potato salad that was out in the sun too long? (also consider a sat phone 🙃)
Note: If you're in a place that might lose power/internet during a natural disaster (e.g. the Bay Area), it can be useful to have a printed guide that you feel comfortable with.
General abilities:
Get comfortable calling the number on the back of your insurance card. A nurse will ask questions and advise you on whether to go to urgent care for stitches or antibiotics or wait until there’s a fever or whatever.
One Medical is available in many states now and can often get you on a video call with a nurse within a few minutes; if the diagnosis is clear, they can even write you a prescription on the spot.
Get comfortable calling urgent care and understanding where they are, when they’re open, what types of things they can handle and what types of things they can’t (so you don’t waste time when the tests or care you need have to come from a hospital). (And also learn the cost -- it's typically cheap if you have insurance, and knowing that can help you seek care before things get out-of-hand.)
But if it’s a not-breathing thing or a major blood-loss thing or a heart attack or something serious (confusion or loss of consciousness are generally danger signs), 911 (or the local emergency number which I generally have in my phone to skip the meta dispatcher) will generally get you onsite medical help faster than you could get to the ER.
Remember the bystander effect and counter it by delegating specific responsibilities to specific people: "You in the green shirt!" <point at person> "call 911 and tell them X, Y, Z and then report back here to me." "You in the white with the beard! <point at person> "Go to the event organizer and see if they have any volunteer medical staff they could send, and then come back here to me."
Psychology is part of the deal: try to keep calm without being disconnected. Make sure you handle your own situation first so that you can safely turn all your attention to helping those who need it. If you're calm and have your shit handled, you'll be better able to keep other people calm, which can be a big boost to administering first aid.
Taking a first aid class will probably help with this a bunch, by giving you greater confidence even if you don’t learn a lot of new things. Often there will be free courses sponsored by the city or county because it’s to everyone’s advantage to have more people who are prepared to help when something goes wrong.
OK, that's what I got for now. Oh, one last note: You’ll probably notice that as you learn how to treat things, you’ll also learn about preventing them, and that can be even more valuable!
My number 1 piece of advice here is another psychological intervention: get comfortable with protective gear, even if it looks nerdy or less bad-ass. Always wear a helmet: skiing, biking, etc. Elbow pads, knee pads, life jackets, seat belts, surgical masks, etc. The hospital staff in the ER or the wound clinic will tell you endless stories about the “cool kids” they see on a daily basis who opted out. 😕