We recently got some fan mail (yes, people do love us) that I think is worth discussing here in more detail. It seems to me that the person had read our ‘4 Bs’ article. Cutting right to the chase, the core question is “Can a first aider leave someone to die?” To which the only logical answer is, “Sometimes,” but you better have a darn good reason. Now, here’s part of the eMail. The other thing worth knowing is that it comes from Nigeria.
I sat under a Medical Doctor for a training on Basic First aid. During the training, he said one of the first priorities of a first aider is to save a conscious person first before the unconscious person and for the three Bs, given an accident scenario, the first thing to do is to stop bleeding first before checking for breathing in the victim or casualty. I tried to argue this out but he said this is based on the Triage Training. In my own view, I think an unconscious person should be attended to since the conscious person is breathing; saving a life is a more urgent task than reducing pain and suffering.
First Aider, or MD?
So, first, we have to point out that we teach first aid. It’s very different from triage training. I have no idea if the MD was trained as a first aid instructor, but it seems unlikely. We shouldn’t confuse our work as first aiders with triage done by an MD. Triage means ‘To Sort’ and while we do that in first aid, it’s not the same as full triage training done by health care professionals.
Pain and Suffering
Next keep in mind that first aid training and the 4 B’s are about saving lives. Sorry, but your comfort is secondary to me – I’m here to save your life. Actually, I think the MD referenced in the email would feel the same way, it’s the person asking the question who has put his own interpretation on the MD’s teaching. So let’s get that out of the way – if you’re acting to save lives, immediate comfort is secondary (but also important in extended care situations).
What are you doing?
Physiologically speaking (studying the way bodies ‘work’) there’s really no point plugging all the holes, and keeping the blood in, if it has no oxygen to carry. The oxygen is essential for life. Undertakers will not give points for pretty bandaging! Still, there’s no point doing CPR if every compression empties half a pint of blood all over the floor. That can’t last long (about 16 compressions before you empty an average adult). In really rough situations, you might need to strike the right balance.
What have you got?
So, can a first aider leave someone to die? Depends on what you got. Let’s imagine two situations:
- 1. Your dumb cousin just shot himself.
- 2. A crazed American teenager just shot up the school (and for some reason you’re there first, on your own)
One is pretty straight forward – use your first aid training to deal with whatever happened, try not to laugh at your relatives, get EMS/ambulance on the way. Not necessarily in that order.
Two is more challenging – who knows what casualties you might meet. So assuming you’re safe to be there….. Let’s give you one person in need of CPR, ten with severe bleeding, and others. You know from your basic training (or because you’ve read our blog) that breathing comes first – so you should do the CPR. You also know (you read this post too) that the survival rate even if you do good CPR isn’t that high without an AED. At the same time, you have enough training and kit that you can stop all ten from bleeding out. You can save ten lives for sure and risk one; or possibly save one while risking ten. So can a first aider leave someone to die? You bet – but it’s a pretty weird situation to be in.
Where are you?
“Can a first aider leave someone to die?” Also depends on where you are. It’s something we actually have to keep in mind here in Sea 2 Sky country – you can quickly find yourself in places ambulances don’t come and helicopters find difficult to reach. If you’re doing CPR in the back country, 4 hours from the last road, 6 hours from any occupied buildings and who knows when you last saw phone reception then we might ask – what are you doing? Practicing? (But there may be plenty of good reasons to keep going.)
But usually, we’re in towns & cities and expecting help to arrive soon. Hospitals and doctors, nurses & others are near by and we generally can expect a degree of success. So we follow the 4 Bs, 3 Cs, 3 Ps and all the other training we’ve had.
Rule of Thumb?
Single casualty and you in ‘civilization’ – breathing/CPR comes first. A long way from help and essentially on your own/small group – do your best but realize it might not work (take a Wilderness course). On your own with so many casualties it scares you – then we have to say ‘yes’ to the initial question of ‘can a first aider leave someone to die’? But you still best have a darn good reason!