General approach

Provide help while maintaining your safety, as well as the safety of the ill or injured person and any bystanders.

The actions of the first person on the scene of a first aid emergency are critical. While providing first aid is important, it is only one aspect of the Chain of survival behaviours. It is important to observe and practise other aspects within first aid education programmes too. While actions may be numbered neatly in steps to take, in reality, many may be done simultaneously. For example, if the first aid provider has a phone, they could call emergency medical services (EMS) using the speakerphone function while still providing care. Underpinning the Chain of survival behaviours is the safety of the first aid provider and their ability to make decisions to act effectively.

Guidelines

Good practice points

Assess the scene
  • First aid providers should be taught about ambiguity in emergencies, and how deciding to act is the most important first step.
  • First aid providers should assess the scene for dangers to themselves or others before providing help.
  • In assessing a scene that contains areas of danger, first aiders should also observe which areas are safe (or have fewer dangers) to provide options for themselves and the ill or injured person.
Assess the person
  • A standard approach to assessment could be taught to first aid providers. This may help them appropriately prioritise care for time-sensitive conditions and feel more confident in their approach.
  • If possible, first aid providers should approach the ill or injured person from the direction they are facing so they can see them coming. This may reduce the risk of scaring the injured or ill person or causing them to move unnecessarily. It may also help keep them at ease.
  • First aid providers should assess the ill or injured person by checking for a response, normal breathing and normal blood circulation. These conditions should be treated as a priority if abnormal.
  • If the ill or injured person can talk or cry, it should be assumed their airway is open and their breathing is adequate.
  • An ill or injured person should be left in the position of most comfort (usually the position that they are found) unless there is a need to move them to a different location or position for safety or wellbeing purposes.
  • First aid providers may assess an ill or injured person further by asking them questions to determine their mental status or medical history or more closely examining part of their body (with consent).
  • The first aid provider should communicate with the ill or injured person, explaining what they are doing to help, and acting with respect and empathy.
Provide care or access help
  • The first aid provider should access emergency medical services (EMS) as soon as they think help is needed. If using a phone, care to the ill or injured person should be provided simultaneously by activating the phone’s speaker function.
  • A lack of first aid equipment should not be a barrier to providing care; first aid providers should use whatever resources are available to them.
  • Filming an emergency incident is inappropriate, particularly if it blocks the path of professional responders. First aid education should raise awareness of this fact.
Multiple casualties
  • The first aid provider should protect themselves at all times from danger, aim to preserve life and reduce injury and suffering.
  • If there is more than one ill or injured person, it may be appropriate to call EMS first to inform them about a potentially critical situation, and then repeat the call once more detailed information has been gathered.
  • In a multiple casualty incident, the first aid provider should assess the ill or injured before providing care and provide care first to those people with the most life-threatening conditions relating to breathing and circulation.

Chain of survival behaviours

Prevent and prepare
  • Know the common risks in your environment, and the steps you can take to help minimise the risk of an incident occurring or worsening.
  • Ensure you have access to a first aid kit or the specific equipment (a disaster kit, hi-visibility signs or clothing, etc) according to your assessed needs and risks.
  • Be aware that diffusion of responsibility (e.g., thinking someone else will help) and ambiguity (e.g. wondering if the person really needs help) are common barriers to overcome in helping an ill or injured person.
  • Learn the emergency services that can help in your context and how to access them. This may involve knowing their phone number, location or the types of questions they may ask.
  • Understand the potential resistance an ill or injured person may have to certain procedures, such as the associated costs of services. Advocate for them accessing care when it is needed.
  • Learn proactive means to de-escalate volatile situations (see De-escalation techniques).
Recognition

Upon entering a first aid situation, be aware of the thoughts and feelings you may have that may affect the help you provide. Be alert to the fact that people read situations differently, and just because no one is responding does not mean that nothing is wrong (the Bystander Effect).

Assess the scene

A scene assessment involves identifying any potential safety risks (to you, the ill or injured person or bystanders), such as fire or exposed electrical wires. The location itself may be unsafe. If the person is in or near a body of water or ice, in a conflict area, or a closed or confined space with minimal oxygen or poisonous gas, extra care must be taken.  Additionally, if there is an active shooter, contamination by chemical, radiological or biological agent, or any other risk you can’t mitigate, stay away and inform the relevant authorities (fire or police).

  • If possible, seek the support of another person who can help you.
  • Assess the scene for potential danger to yourself or the ill or injured person and try to identify the potential cause of the illness or injury.
  • If necessary, observe areas of safety (or ones with fewer dangers) to provide a safe place for you and the ill or injured person.
  • Take steps to make the scene safe. This could include accessing additional help or equipment or by changing your approach based on the danger. Do not approach the scene if it is not safe.
  • Identify the number of ill or injured people.
  • Remain aware of your surroundings and maintain your personal safety. This will be particularly important in Conflict, Disaster or multiple casualty contexts.
Assess the person

Remember to talk to the person as they may be able to indicate what is wrong. Always act with empathy and respect. Tell them what you are doing before you do it.

Identify any life-threatening emergencies requiring immediate action (e.g., the person is not breathing) and what kind of first aid can support their condition.

  1. Is the person responsive?
  2. Is the person’s airway open and clear?
  3. Is the person breathing normally?
  4. Has the person got an injury that is bleeding severely?

This is often called the ‘ABC check’ or ‘primary survey’.  If there is any concern about cross-infection, do this assessment by observing the person’s chest or abdomen for signs of breathing. See Pandemic.

If the person doesn’t have any life-threatening conditions, you may be able to identify and provide support for any non-life-threatening conditions.

  1. Is the person showing signs of an altered mental status (confusion, aggression, etc)?
  2. Does the person have any signs of injury? You may need to examine them more closely.
  3. Does the person have any history of an allergy or medical condition?
  4. How does the person say they feel?
  5. What other signs can you observe in them (temperature, movement, etc)?
First aid steps
  1. Provide care for the conditions you find in the order of severity, focusing first on the person’s breathing and circulation which are critical to survival.
  2. Access help if necessary.
  3. Continue to assess and observe the person. Be alert to any changes in their condition. Take note of any vital signs  if necessary.
  4. Provide care until professional medical care can take over or the person and their support network become self-sufficient. It may be              helpful to signpost to onward care options if available.

 ______________________________

SPECIAL CASE

Multiple casualty incident

  • If there is more than one ill or injured person, call EMS first to inform them about a potentially critical situation, and then call them again when you have detailed information to give them.
  • Quickly assess all the ill or injured before providing care and provide care first to those with the most life-threatening conditions relating to breathing and circulation.

______________________________

Access help
  • Identify what type of help is needed. It may be more than one type of help. For example, rescue service and medical care. Or it may be that you access the next available higher level of care to you.
  • Access emergency medical care as soon as the need is suspected. This will get help to you quicker, and if you are phoning, the call-taker may be able to guide and support your first aid actions.
  • Identify additional resources that could help you in accessing help or providing care, such as bystanders or transportation options.
  • If lifesaving first aid is being provided, access care in the most efficient way possible. This may mean making a call using the speakerphone function, while others may need to arrange transport that allows care to be continued during transportation.
  • In some cases, it might be better to access EMS quickly with incomplete information. For example, accessing EMS early for a full bus crash, even without knowing the exact number of injured will start the process of getting help. In other contexts, more detailed information may be needed. For example, a messenger sent in a remote setting should have detailed information so EMS can send adequate resources to help.
  • If calling EMS, remain calm and answer their questions as clearly and accurately as you can. This will help them prioritise your call.

Education considerations

First aid education can increase the likelihood that a person will get the help they need in a first aid emergency. Education can increase a learner’s intention to help by supporting them to develop confidence and willingness to act. This confidence and willingness may be increased by including helping behaviour messages and activities which span the whole content of an educational intervention, including the general approach to providing care in an emergency.

Context considerations
  • Assessing the scene for danger will vary considerably across contexts. Discuss with learners the types of incidents they are likely to encounter (road traffic collisions, accidents at work or in the home, conflict etc).
  • The role of the first aid provider will also be affected by who else is likely to be on the scene at the time, and this might facilitate or inhibit intervention (Levine et al., 2020). For example, their response might be different if they are alone, if they are with a colleague who can help them, or if they can enlist the help of bystanders.
  • The role of the first aid provider might also be affected by the behaviour of other people, and the relationship of the rescuer to those other people. In some contexts (usually ambiguous, non-violent ones), the can occur where no one responds to an ill or injured person because no one else is doing anything to help (Van de Velde, 2009; Levine & Manning, 2013).  In other contexts (usually unambiguous, violent ones) there may be a ‘reverse Bystander Effect’ with bystanders coming together to respond (Fischer et al., 2011, referenced by Levine et al., 2020).
  • The type of help available will vary based on local factors. Programme designers should ensure their programmes reflect local circumstances. Be aware that help might not be available for all locations or contexts. Learners should be aware of what is available. For example, an urban area may have easy access using an emergency phone number. However, a remote area in the same country may not have access using the same phone number. This may be even more complicated if people travel between the two contexts.
  • Be aware of myths and realities that may exist in local areas that may influence efficient access to care. For example, local taxis might provide faster transportation than ambulances, or this could be a perception which hinders efficient access to care (Jayaraman et al., 2009; Mould-Millman et al., 2015).
  • If there are any barriers to accessing care in a particular context, programme designers should ensure that those barriers are addressed in learning activities (Watts et al., 2011). For example, an emergency phone number may offer language translation or text services, allowing those who do not communicate in the dominant language to still seek help.
  • Raise awareness that some first aid situations may be solved by helping the person connect with their usual care providers.
  • Prepare learners for the type of incidents they are most likely to encounter. For example, in areas where there are frequent traffic collisions, learning should reference these and identify the level and availability of emergency services and others who can help.
  • In preparing people for events such as terror attacks, include individual safety measures and local regulations in the first aid education.
Learner considerations
  • Encourage learners with sensory or physical disabilities to consider how they can complete the assessments of the scene and the person in a way that works with their strengths. Also, work with them to devise strategies that they can use to safely move a person without injuring themselves in the process.
  • Work with learners to develop strategies to overcome fear when faced with an emergency. Use educational approaches which encourage confidence and willingness to act according to learner needs and preferences.
  • Seek to understand learners’ intentions to act and their motivations or barriers to doing so to make your educational approach effective (Miller & Pellegrino, 2018; Herd et al., 2020; see Motivation to learn topic).
Facilitation tips
Assess the scene
  • First aid providers find it most difficult to decide to act. Learners should be taught about ambiguity and how deciding to act is the most important first step (Vaillancourt et al., 2008).
  • Guide learners to reflect on their own experiences with helping in the past. The theme of ambiguity and the Bystander Effect may come up in stories shared by learners (or the facilitator). Bringing up these themes as lived experiences will help learners who have not experienced these feelings to relate to these concepts.
  • Since there are a large number of potential safety hazards, focus on the principle of scene assessment: identify and manage dangers. Allow learners to identify potential dangers within their contexts, as well as solutions that they would consider. (See Scene assessment resource.)
  • Focus on how learners can eliminate, control or work around potential dangers. Avoid focussing on what learners should not do when faced with danger as this may discourage any action instead of encouraging safe action.
  • Supplement discussion of potential dangers with specific instruction for any risks where the probability of the risk is high or where there is misinformation present. Consider the work and guidance of other programs (both inside and outside of the Red Cross Red Crescent) to ensure synergy.
  • Depending on the situation, the first aid provider may need to decide whether to move the ill or injured person. The first aid provider should only move the person if they are in danger, need to travel to medical care, or if the person is in a position that makes it difficult to assess and provide care. First aid providers will need to balance the risk that may be caused by moving the ill or injured person, versus the risk of not moving them. 
Assess the person
  • An organised framework to guide assessing the ill or injured person, (e.g., ABC) may help learners to be thorough, and prioritise the care that may be required. (See Assess the person resource.)
  • Emphasise that the environment may evolve, both quickly and slowly. For example, tensions may suddenly escalate, or weather patterns may begin to shift over time. As well, some characteristics of the ill or injured person may not be immediately known, especially if they live with a disability. As a result, first aid providers should continue to remain attentive to their environment and the ill or injured person, changing their approach with the situation.
  • Even though a first aid provider may not be able to access an ill or injured person in an unsafe environment, first aid providers should consider creative solutions. For example, the first aid provider may be able to verbally coach the ill or injured person in assessing and caring for themselves from a distance.
Access help
  • All first aid education should include identifying the types of help and resources they can draw on, how to access them, as well as help learners to determine whether to first access help or provide care, depending on the situation. (See Access help resource.)
  • Emphasise to learners in contexts with an active EMS phone system in place that they can access help as soon as they suspect they need it. This may help give them confidence in their actions.
  • Help learners understand the community resources they can draw on for help. This could include neighbours or bystanders, or the environment (shelter, water, etc). Bystanders, for example, can be asked to control a crowd, to protect the dignity of the ill or injured by forming a barrier, to create shade over or block cold wind or rain with a tarp (sheet), go to the nearest phone to call for help, or to get equipment such as a defibrillator.
Multiple casualty incident
  • Simulations are an educational tool that may be used to develop critical-thinking skills, awareness and preparedness for a multiple casualty incident among first aid providers and healthcare professionals.
  • Highlight to learners that a multiple casualty incident is an event that results in multiple injured people, outnumbering and overwhelming emergency medical services. This situation includes road traffic collisions, terror attacks, multiple shootings and disasters.
  • If possible, include professional responders, healthcare workers, Red Cross Red Crescent volunteers, civil organisations and other appropriate groups in the exercise. Doing so will help people to understand each other’s function and role before an actual event.
  • Run simulations on-site or using virtual reality.
  • Empower learners by removing any barriers to action and have them practise using the equipment they might have close at hand (e.g., clothing to control bleeding).
  • Explain the process of triage and prepare learners to manage onlookers. 
Facilitation tools
  • Use role-play to practise developing confidence in assessing the scene, moving people and asking others to help. Roleplay can also be useful to practise the process of calling for help, such as the type of questions they may be asked.
  • A memory tool may be used to help learners remember the important things to do when assessing a person. ABC is a common tool used. (See Assess the person resource.)
  • Encourage learners to program emergency access phone numbers into their phones, particularly if they don’t have an easy-to-remember phone number, or if travelling to a new area with different phone numbers.
  • Create or find spaces which are awkward and have learners to practise helping people in different positions. For example, set up a scenario where a person has collapsed in a small toilet cubicle or on the stairs.
Learning connections
  • See the topics on Disaster context and Conflict context for situations where there could be many injured people.
  • The movement of someone with a suspected spinal injury should be minimised. (See Spinal injury.)
  • If a person is unresponsive, open their airway and check for breathing. (See Unresponsiveness.)
  • It is often helpful to highlight to learners that the mechanism (cause) of injury may be a risk for their safety.
  • Bleeding control is a key skill for a multiple casualty context.

 

Scientific foundation

Non-systematic review
Helping behaviour and the Bystander Effect

There is a large body of literature on helping behaviour and the Bystander Effect.  We have selectively drawn evidence from literature sources which are specific to first aid interventions.

Systematic reviews on this topic are provided by Vaillaincourt et al. (2007) and Van de Velde (2009). Vaillaincourt considers bystander CPR rates and concludes that a lack of interest and motivation to learn CPR skills contributes to the reluctance to intervene and provide CPR in real situations. They also identify barriers such as the ambiguity of situations as being important in influencing the decision of a bystander to intervene. Van de Velde concludes that first aid programmes that train participants to overcome inhibitors of emergency helping behaviour could lead to better help and higher helping rates.

Training in first aid is also linked to increased confidence to help in an emergency, as documented by Heard et al. (2020) in a scoping review. The review considers public confidence in first aid skills and willingness to help during an emergency and barriers to or enablers of learning first aid and delivering first aid in an emergency. The findings identify high levels of perceived knowledge, confidence, and willingness to help, supporting the idea that the public can play a vital role during an emergency. However, the findings also point to low uptake levels, and barriers to learning first aid and helping, indicating that the first aid education landscape needs improvement.

Another review of literature is provided by Levine et al. (2020) which draws on previous literature about the Bystander Effect and argues that more recent evidence proves this phenomenon does not apply in violent or dangerous emergencies. They refer to meta-analyses as well as recent research of closed-circuit television (CCTV) footage which reveals that bystander intervention is, in fact, the norm. They also draw on studies of social identity (such as Levine and Manning, 2013) which support theories that individuals are most likely to help people they know (family members, friends and colleagues). Nonetheless, in violent and dangerous situations, the willingness of people to intervene could be due to the emergence of a ‘group membership’ that forms amongst strangers who are all present at the same event at the same time.

There is a lack of evidence to support any one particular approach to developing ‘helping behaviour’ through first aid education. Different situations, cultures and legislatures influence behaviour and attitudes to helping, and where there are studies, they are incomparable in terms of outcome measures and variables. We identify this gap whilst acknowledging a growing body of evidence on education which explores the development of the confidence and willingness of the learner to act such as Miller & Pellegrino, 2018). 

Role of first aid providers

As the first people on the scene, first aid providers can play a vital role in caring for the injured before professional help arrives. Properly preparing providers is critical to ensuring their skills and efficacy (van Romburgh & Mars, 2019).  Awareness of this role is critical in all first aid situations and supporting learners to act as well as to call for help is identified by Oliver et al. (2017a & b).

Confidence to act without proper equipment

Providers need to understand that a lack of equipment does not mean they are unable to help. Providing CPR or controlling bleeding with clothing (or the person’s hand) are examples of life-saving actions without any equipment (Jacobs et al., 2016; van Romburgh & Mars, 2019).

Bystander filming

Management of the accident scene has traditionally focused on preventing further danger. However, cultural developments create new challenges for responders (Bazeli et al., 2017). One such challenge is that some bystanders now film the incident, not only humiliating the injured person but also actively blocking the path of professional responders. It is important to emphasise the danger of this action to learners.

Implications of bystander first aid

Jacobs et al., (2016) noted the need to acknowledge bystanders as those able to respond immediately to ill or injured people. Bystanders (first aid providers) should be included in a reorganised response structure and be empowered through the recognition of their role in responding to emergencies. Conversely, another paper warns of the potential damage bystanders can do, such as pulling people out of cars at road traffic incidents (Bazeli et al., 2017). Both studies identified that education is critical to increasing survival rates from multiple casualty events.

Turner et al., (2016) identified that haemorrhage is the leading preventable cause of death in trauma. They also stated that equipment to control bleeding, as well as public education on how to do so, should be made widely available. In a separate opinion paper about improvised first aid techniques for terror attacks, Loftus et al., (2018) suggested empowering providers to get creative and use everyday items to make first aid equipment that can save lives.

Importance of agency coordination

Bazeli et al. (2017) completed a qualitative study in Iran using semi-structured interviews to get insight from different participant groups on the management of multiple casualty traffic incidents. Reports stated there was poor coordination between agencies, duplicated efforts by different organisations and no centralised or integrated command system.

After a multiple casualty training and mock event trial in Sierra Leone, Leow et al. (2012) concluded that when high-resource logistics are applied to environments with limited resources, the result is insufficient systems for transport, tracking and adequate resourcing. Participants identified inter-agency coordination as the most valuable lesson learned.

Turner et al. (2016) conducted a systematic review that identified a need for inter-agency leadership and coordination to be developed in advance as poor communication was a consistent feature when responding to multiple casualty civilian shooting incidents.

Simulation training

Simulations are an opportunity to create a life-like environment where facilitators can teach providing first aid in a multiple casualty incident.

  • Wilkerson et al. (2008) showed that immersive training through a virtual reality simulation is a powerful educational tool. The simulation helped first responders to identify how a chaotic, stressful environment challenges the knowledge and skills learned in the classroom.
  • Cicero et al. (2018) had positive results when they tested a video game to explore whether it would improve triage accuracy within the game.
  • Yanagawa et al. (2018) explored a simulation used as part of a multiple casualty life support course. The results showed the intervention group (who completed the simulation) performed first aid significantly better than the control group.

These three studies were conducted with healthcare professionals or trained rescuers and therefore, cannot be applied without adaptation to first aid providers. However, they do demonstrate the value of simulations for multiple casualty education, and we encourage further exploration of adapting this tool for general first aid providers.

Outside of healthcare and trained rescue professionals, a different paper concluded that regular and specific preparedness exercises are essential. These activities should take place at schools and other public areas and involve both the local public and private authorities (Turner et al., 2016).

Triage by first aid providers

The study by Leow et al. (2012) in Sierra Leone included Red Cross personnel who correctly triaged people in the simulation exercise.

Badiali et al. (2017) conducted a case-control study and assessed 400 basic life support participants in using a rapid assessment tool when responding to multiple casualty incidents. The participants consisted of non-medical ambulance crews, with 200 participants in both the intervention and control group. The intervention group completed a brief START training with the tool 30 minutes before the exercise while the control group did not. The intervention group correctly triaged 94.2 per cent of the cases; the control group did so in 59.83 per cent of cases. However, this study was theory-based rather than practical meaning that triage may look very different in a real-life situation.

References

Systematic reviews

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
Full Text article

Vaillancourt, C., Stiell, I. G., & Wells, G. A. (2008). Understanding and improving low bystander CPR rates: a systematic review of the literature. Canadian Journal of Emergency Medicine, 10(1), 51-65. Retrieved from
https://pdfs.semanticscholar.org/9726/31a4e11b17dc8b3c400c858c19f16d9802a8.pdf

Van de Velde, S., Heselmans, A., Roex, A., Vandekerckhove, P., Ramaekers, D., & Aertgeerts, B. (2009). Effectiveness of non-resuscitative first aid training in laypersons: a systematic review.
Full text article

Non-systematic reviews

Fischer, P., Krueger, J. I., Greitemeyer, T., Vogrincic, C., Kastenmüller, A., Frey, D., … & Kainbacher, M. (2011). The bystander-effect: a meta-analytic review on bystander intervention in dangerous and non-dangerous emergencies. Psychological bulletin, 137(4), 517.
Full text article

Heard, C. L., Pearce, J. M., & Rogers, M. B. (2020). Mapping the public first‐aid training landscape: a scoping review. Disasters, 44(1), 205-228. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/disa.12406

Levine, M., Philpot, R., & Kovalenko, A. G. (2020). Rethinking the Bystander Effect in Violence Reduction Training Programs. Social Issues and Policy Review, 14(1), 273-296. Retrieved from https://spssi.onlinelibrary.wiley.com/doi/pdf/10.1111/sipr.12063

Levine, M., & Manning, R. (2013). Social identity, group processes, and helping in emergencies. European Review of Social Psychology, 24(1), 225-251.  Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10463283.2014.892318 

Education references

Badiali, S., Giugni, A., & Marcis, L. (2017). Testing the START triage protocol: Can it improve the ability of nonmedical personnel to better triage patients during disasters and mass casualties incidents. Disaster Medicine and Public Health Preparedness, 11(3), 305–309.

Bazeli, J., Aryankhesal, A., & Khorasani-Zavareh, D. (2017). Exploring the perception of aid organisations’ staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study. Electronic Physician, 9(7), 5212–5222. DOI 10.19082/4773

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

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

Jayaraman, S., Mabweijano, J. R., Lipnick, M. S., Caldwell, N., Miyamoto, J., Wangoda, R., … & Ozgediz, D. (2009). Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-firstresponder training program. World journal of surgery, 33(12), 2512-2521. Retrieved from http://global.surgery.ucsf.edu/media/7825568/Jayaraman-2009.pdf

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.
Full text article

Mould-Millman, N. K., Rominski, S. D., Bogus, J., Ginde, A. A., Zakariah, A. N., Boatemaah, C. A., … & Campbell, T. B. (2015). Barriers to accessing emergency medical services in Accra, Ghana: development of a survey instrument and initial application in Ghana. Global Health: Science and Practice, 3(4), 577-590.
Full text article

Oliver, G. J., Walter, D. P., & Redmond, A. D. (2017a). Prehospital deaths from trauma: Are injuries survivable and do bystanders help?. Injury, 48(5), 985-991. Retrieved from https://www.sciencedirect.com/science/article/pii/S0020138317300979

Oliver, G. J., Walter, D. P., & Redmond, A. D. (2017b). Are prehospital deaths from trauma and accidental injury preventable? A direct historical comparison to assess what has changed in two decades. Injury, 48(5), 978-984. Retrieved from https://www.sciencedirect.com/science/article/pii/S0020138317300608

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
Full text article 

Watts, J., Cowden, J. D., Cupertino, A. P., Dowd, M. D., & Kennedy, C. (2011). 911 (nueve once): Spanish speaking parents’ perspectives on prehospital emergency care for children. Journal of immigrant and minority health, 13(3), 526-532. Retrieved from
https://link.springer.com/article/10.1007/s10903-010-9422-9

Wilkerson, W., Avstreih, 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.

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

De-escalation techniques for violent behaviour
Conflict context
Disaster context

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Published: 15 February 2021

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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

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.

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