Improvised first aid techniques for terrorist attacks

Abstract

Terrorist acts occur every day around the world. Healthcare professionals are often present as bystander survivors in these situations, with none of the equipment or infrastructure they rely on in their day-to-day practice. Within several countries there has been a move to disseminate the actions to take in the event of such attacks: in the UK, , and in the USA, This paper outlines how a very basic medical knowledge combined with everyday high-street items can render highly effective first aid and save lives. We discuss and summarise modern improvised techniques. These include the <C> ABCDE approach of treating catastrophic haemorrhage before airway management, bringing together improvised techniques from the military and wilderness medicine. We explain how improvised tourniquets, wound dressings, splinting and traction devices can be fabricated using items from the high street: nappies, tampons, cling film, duct tape and tablecloths. Cervical spine immobilisation is a labour-intensive protocol that is often practised defensively. With little evidence to support the routine use of triple immobilisation, this should be replaced with a common sense dynamic approach such as the Montana neck brace. Acid or alkali attacks are also examined with simple pragmatic advice. Analgesia is discussed in the context of a prehospital setting. Pharmacy-obtained oral morphine and diclofenac suppositories can be used to treat moderate pain without relying on equipment for intravenous/intraosseous infusion in prolonged hold situations. The differentiation between concealment and cover is summarised: scene safety remains paramount.

Advancing the scientific study of prehospital mass casualty response through a Translational Science process: the T1 scoping literature review stage

“…References from the PHLSDC scoping review highlighted the need to focus on assessment and treatment guidelines for crush injuries during MCIs [ 46 , 63 , 75 ], as well as for the development of awareness on chemical, biological, radiological, nuclear, and explosive (CRBNE) events, advocating for education, training, and competencies to be developed across all agencies [ 48 , 57 , 71 , 76 , 79 , 81 ]. Similarly, control of major hemorrhages as an integral part of the triage process emerged as a recurrent topic in the included PHLSDC references, with a special emphasis on the role of non-medical bystanders, as specifically stressed by the Hartford Consensus after the Sandy Hook Elementary School mass shooting and by Lesaffre and colleagues after the 2015 Paris attacks [ 46 – 48 , 50 , 51 , 61 – 63 , 73 , 77 , 80 , 169 ]. Overall, attention was given to the importance of continuous real-time monitoring and re-assessment of casualties to guide prioritization of life-saving interventions and transportation, suggesting the possibility to introduce deployable technology, provided it to be quick, reliable, and easy to use [ 48 , 50 , 54 – 56 , 63 , 69 , 75 , 76 ].…”

The Efficacy of Novel Commercial Tourniquet Designs for Extremity Hemorrhage Control: Implications for Spontaneous Responder Every Day Carry

“…In the absence of commercial TQs, lay-providers would be forced to fashion improvised TQs, which are less effective in controlling exsanguinating extremity hemorrhage than their commercial counterparts. [9][10][11] Several novel commercial TQ designs have been developed that are smaller than conventional military TQs, and therefore may be more amenable to EDC. These designs might improve layprovider capability when responding to events, including highthreat incidents.…”