Disasters can be natural (e.g., earthquakes or flooding), man-made (e.g., explosions or chemical spills) or a combination of both (e.g., fires). The unexpected nature and scale can affect large numbers of people and all aspects of a community. People in disaster situations often sustain injuries and require lifesaving first aid. Communities with the confidence and willingness to act and the skills to provide care will be better prepared to respond to a disaster.
The disaster context is more complex than urban or remote contexts in that the infrastructure that may have existed prior to the disaster is either temporarily or permanently disabled. This means that access to medical resources or care is often delayed for an extended period of time. Additionally, the instability of the environment may pose significant safety risks (e.g., likelihood of aftershocks following an earthquake).
Guidelines
Good practice points
- First aid education should emphasise the hazards in different disaster settings, as well as what help might be available and how to access it.
- First aid education programmes should focus on developing learner’s ability to adapt to the disaster’s context and any limitations they might face (such as reduced access to water or equipment, delayed access to emergency services).
- First aid education should support learners to prepare for disaster including knowing the risks, making an emergency plan, and getting an emergency kit.
- First aid education organisations should work with local and national authorities and emergency response agencies to establish response mechanisms involving the public, as well as identify appropriate messaging.
- Different forms of media communication should be considered to motivate and empower the public to learn how to respond effectively in disaster situations.
- First aid education should focus on life-saving skills (e.g., putting pressure on a severe bleed) and the use of improvised equipment (e.g., using a shirt to stop the bleeding). It should also include content on recovery and minimising further injury and risk of infection.
- First aid education programme designers should consider educating pre-formed groups, such as workforces, to develop an effective response as a team. This should include facilitating regular refresher opportunities. See Refresh and retrain.
Education considerations
Context considerations
- Frame disaster preparedness education so that it reflects the likely hazards within a particular context.
- To respond and recover, communities need communication systems to ensure collaboration and clear roles and responsibilities. They also need recovery planning that includes a range of different people and agencies.
- Help learners understand the risks they may face by encouraging them to think about the possibilities relevant to their context. Each of these types of factors influence how they should plan and what they need in their preparedness kit. Consider hazards and their impact such as:
> whether a person lives alone or with a family
> whether there are children or someone with mobility issues
> if they live in a tall building or a house.
Learner considerations
- Make time to explore the responses people might have to a disaster such as experiencing high emotions or filming it on camera. Discuss how to manage emotions and the positive or negative outcomes of behaviours.
- Educate groups that act as a community – such as those in workplaces, schools and community centres. Involve local emergency services when possible (Wynch et al., 2011).
Facilitation tips
- Emphasise that individuals can play a critical role immediately after a disaster as the time it takes for emergency medical services (EMS) to respond can vary enormously from hours to days or even weeks (Jacobs et al., 2016).
- Concentrate on bleeding control, maintaining an open airway and shock. A focus on simple steps for stabilising life-threatening conditions is paramount (Bazeli et al., 2017; Jacobs et al., 2016; Loftus et al., 2018; Turner et al., 2018).
- Emphasise the importance of infection prevention, especially as first aid supplies may not be readily available.
- Stress the importance of learners applying all the first aid steps which are possible to reduce pain and suffering and further harm, even when it is not possible to apply all the steps in a particular context or situation.
- Emphasise the role of bystanders as immediate responders and build learners’ confidence to act, alongside their skills and knowledge.
- Encourage communities and families to prepare for disasters by creating their own disaster preparedness kit to meet their basic needs for the first three days after a disaster. Kits are filled with essentials such as a torch, water, and toiletries and are kept in a place where they can be quickly accessed. Make sure everyone knows the location of their emergency kit.
- Encourage learners to improvise in the likelihood that first aid supplies are unavailable or inaccessible (Gordon et al., 2019; Jacobs et al., 2016; van Romburgh & Mars, 2019).
- Consider building these sessions into preparedness education:
> scene safety
> size and scope of the disaster and identifying immediate needs
> resource assessment for short, medium and long term
> available help (e.g., bystanders or EMS)
> what level and type of triage is possible (both according to the skills of the provider and the needs of the ill or injured people).
Facilitation tools
- The Global Disaster Preparedness Centre is a reference centre to support innovation and learning in disaster preparedness. Visit preparecentre.org to learn more about citizen preparedness for disaster.
- Practical exercises or role-play scenarios are an important part of disaster preparedness. These exercises should include focusing on the safety and security of first aid providers and the people they are helping.
- If programme designers have access to country-specific preparedness apps, they should consider using these to prepare the population and motivate them to learn first aid.
- Help learners develop their own emergency plan. It is important to ensure that everyone is prepared and informed in the event of a disaster or emergency. A family group may not always be together when these events take place and should have plans for making sure they are able to contact and find one another.
> Determine the best ways to evacuate your home in case of an emergency such as a home fire, as well as a safe place to meet.
> Know the plans for your workplace, school, community centre, etc. in the event a disaster happens when you are not at home.
> In the event of a disaster, listen to local radio and television. If local officials or community leaders ask you to evacuate your neighbourhood, follow the routes and go to the location specified. Do not take shortcuts as they could take you to a blocked or dangerous area.
Scientific foundation
Non-systematic review
Papers for this review were sourced from the original literature search for qualitative and quantitative insight on first aid education and supplemented with insight from experts in the field who were also able to suggest additional evidence sources.
Understanding disaster contexts and the varying impact of different hazards
Johnston et al. (2014) and Salita et al. (2019) explored why disasters happen and how to characterise them, providing insight into the likely injuries and harm caused. Both authors draw on the Extended Parallel Process Model of Behavior (Witte, 1992 &1994), which proposes that increasing personal efficacy and threat perception encourages attitudes, intentions and behaviours that can lead to improved disaster preparedness in individuals. In other words, training people how to respond, instilling the willingness and ability to do so, and clearly communicating the threat level of different disasters can better equip people to prepare for disasters. The training links a person’s belief that their actions will help to control the situation (either the danger or the fear they feel) and affect its outcome (Ejeta et al., 2015). Understanding context, including site-specific hazards, the available help and how to access it in real-time, can be important for preparing populations for disaster.
Integrating lay response with the emergency services
Studies from different countries have highlighted a shared challenge of integrating response systems and the ability to make use of lay responders. Bazeli et al. (2017), Leow et al. (2012) and Turner et al. (2016) identified the problem as existing between the response agencies where lack of coordination, delineation of duties and other deficiencies reduce the effectiveness of the response. The Institute of Medicine’s workshop on Medical Surge Capacity in 2010 articulated the barriers to gaining acceptance from emergency response agencies for increased first aid training and lay responder roles (IOM, 2010). Participants identified the need for public preparedness training and for public involvement in the research and development of communication strategies. However, they also pressed the point that this would only be worthwhile if EMS had already engaged with the public. Public training that is endorsed or supported by EMS providers could help to minimise the disconnect.
Motivation to act
The public needs to understand how they can help (and not hinder) a response and what factors will affect their motivation to respond. There is an emerging body of evidence on the motivation to respond. See Miller and Pellegrino’s paper on Intent to Aid (2017), Jacobs et al.’s paper on empowering the public through the recognition of their critical role (2016), and Pellegrino and Asselin’s paper on motivations to learn first aid (2020). Oliver et al. (2014) and Muise and Oliver (2016), both explore the need to develop the confidence and willingness of learners within first aid courses, as well as their skills and knowledge. These papers do not consider disaster on a significant scale, but the findings could apply across large scale and more personal disasters.
Wynch et al. (2011), in their paper on reflections of the community response following Hurricane Katrina, found benefits to training people in identified communities (such as workplace teams). They found that working together in a real situation, as they had trained for, fostered pride, professionalism and humbleness. The paper concludes with a recommendation to policymakers to consider this kind of community engagement when planning education and building community resilience.
The Institute of Medicine focused on the role of media and effective communication to promote preparedness and resilience messages to the public as a mechanism to generate a response. In their notes from a workshop in 2015, they explicitly recommend that emerging media types, branding and promotion are essential tools to mobilise individuals and communities to engage in disaster response. Wilson et al. (2005) reported a strong use of media to inform the public in New Zealand on how to respond to a flood emergency. See the section on Media learning within the Education chapter of these Guidelines for more information.
Focus of first aid education for disaster preparedness
Several authors focused on the crucial elements of first aid education when considering disaster preparedness. These are:
- Bleeding control, open airway and shock: Focus on the critical importance of simple steps for stabilising life-threatening conditions (Bazeli et al., 2017; Jacobs et al., 2016; Loftus et al., 2018; Turner et al., 2018).
- Injury prevention and infection control in the early recovery phase of a disaster: Focus on safety and implementing methods to prevent a dependence on the professional healthcare system (Johnston et al., 2014).
- Leadership: Encourage leaders to feel confident and organised enough to distribute lay and professional responders’ skills and willingness to engage in a broad range of areas after a disaster (Kay, 1984).
- Refresher training: Use methods such as digital games to regularly reinforce skills and psychological preparedness for unexpected emergencies (Cicero et al., 2018; Mohamed-Ahmed et al., 2016; Turner et al., 2016; Wilkerson et al., 2008; Yanagawa et al., 2018).
- Improvisation: Incorporate training that encourages learners to improvise when first aid supplies are unavailable or inaccessible (Gordon et al., 2019; Jacobs et al., 2016; van Romburgh and Mars, 2019).
- Memory aids: Suggest using an app or carrying an information card in a wallet. First aid providers might be reassured to know that professional responders consult checklists en route to (as well as during) an emergency (Motola, 2015).
- Human factors: Understand how human factors affect communication, leadership and teamwork (Hunziker et al., 2010).
Understanding human response to disasters
Ejita et al. (2015) examined articles on behavioural theory and how this applies to human response during disasters. Studies that consider how human factors affect the response, particularly for medical response teams, is currently a gap in our Guidelines. However, we anticipate further work on this topic in relation to first aid education.
References
Non-systematic reviews
Bazeli, J., Aryankhesal, A., & Khorasani-Zavareh, D. (2017). Exploring the perception of aid organizations’ staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study. Electronic Physician, 9(7), 4773. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586992/
Cicero, M. X., Whitfill, T., Walsh, B., Diaz, M. C., Arteaga, G., Scherzer, D. J., Goldberg, S., Madhok, M., Bowen, A., Paesano, G., Redlener, M., Munjal, K., Kessler, D., & Auerbach, M. (2018). 60 seconds to survival: A multisite study of a screen-based simulation to improve prehospital providers disaster triage skills. AEM Education and Training, 2(2), 100–106. DOI https://doi.org/10.1002/aet2.10080
Ejeta, L. T., Ardalan, A., & Paton, D. (2015). Application of behavioral theories to disaster and emergency health preparedness: A systematic review. PLoS Currents. DOI https://doi.org/10.1371/currents.dis.31a8995ced321301466db400f1357829
Hunziker, S., Tschan, F., Semmer, N. K., Howell, M. D., & Marsch, S. (2010). Human factors in resuscitation: Lessons learned from simulator studies. Journal of Emergencies, Trauma and Shock, 3(4), 389–394. DOI https://doi.org/10.4103/0974-2700.70764
Institute of Medicine. (2010). Medical surge capacity: Workshop summary. The National Academies Press. DOI https://doi.org/10.17226/12798
Institute of Medicine. (2015). Communicating to advance the public’s health: Workshop summary. The National Academies Press.
Jacobs, L. M., Warshaw, A. L., & Burns, K. J. (2016). Empowering the public to improve survival in mass casualty events. Annals of Surgery, 263(5), 860–861. DOI https://doi.org/10.1097/SLA.0000000000001517
Johnston, D., Standring, S., Ronan, K., Lindell, M., Wilson, T., Cousins, J., Aldridge, E., Ardagh, M. W., Deely, J. M., Jensen, S., Kirsch, T., & Bissell, R. (2014). The 2010/2011 Canterbury earthquakes: context and cause of injury. Natural Hazards, 73(2), 627 637. DOI https://doi.org/10.1007/s11069-014-1094-7
Kay, B. J. (1984). ‘Barefoot doctors’ in rural Georgia: The effect of peer selection on the performance of trained volunteers. Social Science & Medicine, 19(8), 873–878. DOI https://doi.org/10.1016/0277-9536(84)90405-2
Leow, J. J., Brundage, S. I., Kushner, A. L., Kamara, T. B., Hanciles, E., Muana, A., Kamara, M. M., Daoh, K. S., & Kingham, T. P. (2012). Mass casualty incident training in a resource-limited environment. British Journal of Surgery, 99(3), 356–361. DOI https://doi.org/10.1002/bjs.7762
Loftus, A., Pynn, H., & Parker, P. (2018). Improvised first aid techniques for terrorist attacks. Emergency Medicine Journal, 35, 516–521. DOI https://doi.org/10.1136/emermed-2018-207480
Miller, B., & Pellegrino, J. L. (2018). Measuring intent to aid of lay responders: Survey development and validation. Health Education & Behavior, 45(5), 730–740. DOI https://doi.org/10.1177/1090198117749257
Mohamed‐Ahmed, R., Daniels, A., Goodall, J., O’Kelly, E. & Fisher, J. (2016), ‘Disaster day’: Global health simulation teaching. The Clinical Teacher, 13(1), 18–22. DOI https://doi.org/10.1111/tct.12349
Muise, J., & Oliver, E. (2016). The skill and the will: First aid education to increase bystanders’ propensity to act in Canada. Resuscitation, 106, 45–46. DOI https://doi.org/10.1016/j.resuscitation.2016.07.108
Oliver, E., Cooper, J., & McKinney, D. (2014). Can first aid training encourage individuals’ propensity to act in an emergency situation? A pilot study. Emergency Medicine Journal, 31(6), 518–520. DOI https://doi.org/10.1136/emermed-2012-202191
Pellegrino, J., & Asselin, N. (2020). Theoretical organization of motivations to attend first aid education: Scoping review. International Journal of First Aid Education, 3(1) 18–29. DOI https://doi.org/10.21038/ijfa.2020.0105
Salita, C., Liwanag, R., Tiongco, R. E., & Kawano, R. (2019). Development, implementation, and evaluation of a lay responder disaster training package among school teachers in Angeles City, Philippines: Using Witte’s behavioral model. Public Health, 170, 23–31.
DOI https://doi.org/10.1016/j.puhe.2019.02.002
Turner, C. D. A., Lockey, D. J., & Rehn, M. (2016). Pre-hospital management of mass casualty civilian shootings: A systematic literature review. Critical Care, 20. DOI https://doi.org/10.1186/s13054-016-1543-7
van Romburgh, C., & Mars, A. (2019). Making First Aid More Accessible During Mass-Casualty Incidents. International Journal of First Aid Education, 2(2). DOI https://doi.org/10.21038/ijfa.2019.0007
Wilkerson, W., Av Tstreih, D., Gruppen, L., Beier, K. P., & Woolliscroft, J. (2008). Using immersive simulation for training first responders for mass casualty incidents. Academic Emergency Medicine, 15(11), 1152–1159. DOI https://doi.org/10.1111/j.1553-2712.2008.00223.x
Wilson, N., McIntyre, M., McDonald, M., Tanner, H., Hart, K., Tomlinson, R., Thach, T., Campion, V., Lee, D., Morrison, F., Andersen, E., & Bibby, S. (2005). Communication and health protection issues arising from a flooding emergency. Prehospital Disaster Medicine, 20(3), 193–196. DOI: https://doi.org/10.1017/S1049023X00002442
Witte, K. (1992). Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs, 59(4), 329–349. Retrieved from https://www.academia.edu/7323512/Putting_the_fear_back_into_fear_appeals_The_extended_parallel_process_model
Witte, K. (1994). Fear control and danger control: A test of the extended parallel process model. Communication Monographs, 61(2), 113–134. DOI https://doi.org/10.1080/03637759409376328
Wyche, K. F., Pfefferbaum, R. L., Pfefferbaum, B., Norris, F. H., Wisnieski, D., & Younger, H. (2011). Exploring community resilience in workforce communities of first responders serving Katrina survivors. American Journal of Orthopsychiatry, 81(1), 18–30. DOI https://doi.org/10.1111/j.1939-0025.2010.01068.x
Yanagawa, Y., Omori, K., Ishikawa, K., Takeuchi, I., Jitsuiki, K., Yoshizawa, T., Sato, J., Matsumoto, H., Tsuchiya, M., & Osaka, H. (2018). Difference in first aid activity during mass casualty training based on having taken an educational course. Disaster Medicine and Public Health Preparedness, 12(4), 437–440. DOI https://doi.org/10.1017/dmp.2017.99
Related topics
Explore the guidelines
Published: 15 February 2021
First aid
Explore the first aid recommendations for more than 50 common illnesses and injuries. You’ll also find techniques for first aid providers and educators on topics such as assessing the scene and good hand hygiene.
First aid education
Choose from a selection of some common first aid education contexts and modalities. There are also some education strategy essentials to provide the theory behind our education approach.
About the guidelines
Here you can find out about the process for developing these Guidelines, and access some tools to help you implement them locally.