Emergency Medicine: What medical training would I need to be useful in the aftermath of a disaster?

It is not always the case that large scale emergencies happen in areas where there is the ability to rely, immediately, on the traditional and well-trained response of Emergency Teams. Even when they do happen in populated areas where the response is likely to be swift, there will, inevitably, be a time delay before the first responders are 'on the ground'. There is much that individuals can do to improve the chances of the injured surviving. At the most basic level, it would be helpful if everyone knew how to perform Basic Life Support (BLS) Knowledge of how to open an airway and how to slow haemorrhage (blood loss) is also basic knowledge that can, and does save lives. However, the unfortunate fact in mass casualty incidents is that those patients who have suffered immediate cardiac arrest, ie cessation of a pulse, are likely to have suffered catastrophic and possibly unsurvivable injury. To that end, in mass casualty incidents, those individuals would often be 'over-looked' by the medical professionals in favour of those who are, to be brutally honest, salvageable. Harsh but true. This basic level of knowledge can be obtained relatively easily and at low cost with local providers of First Aid training - the St John Ambulance and The British Red Cross are the main providers in the UK. There will be similar elsewhere. So, start basic and move up. In the UK, there is a scheme which trains members of the community to act as 'First Responders', this equips them with the equipment (including defibrillator) and the training to respond to incidents where professional help may be delayed - due to geographical location for example. Additionally, local Mountain Rescue organisations also often offer emergency response training. There are training organisations which offer more advanced training over a short duration, often two or four days. These are often targeted at those individuals who are likely to travel to remote areas for trek or expedition purposes. These courses would certainly equip someone to be genuinely helpful after a large scale incident. For example, a course run in the UK over two days offers: Measuring vital signs and examination of chest and abdomen Cardio-Pulmonary Resuscitation Shock (this is a fascinating subject!) ABC approach to injured casualties (again, fascinating) Moving, lifting and straightening a casualty Soft tissue Injuries and burns Head, neck, chest and abdominal injuries Fractures, dislocations and use of splints Common medical conditions (including diarrhoea) Cold injuries Tropical problems. (this is a course run by a group calked Wilderness Medical Training - I merely googled and have no affiliation with them) As an Emergency Department specialist and Instructor, a course like that seems to offer a fairly good overview of the skills and knowledge which would allow an individual with no medical training to be prepared to start to help immediately after an incident and to be useful when the emergency response teams arrive. One of the most injured casualties after the London tube bombings was saved because a 'bystander' who had also been involved in the incident, applied pressure to the massive bleeding which resulted after traumatic amputation of limbs. It does make a difference. Knowing when to step in and when to step away are crucial - to people like me too who 'know stuff'. It is also important to be aware of how hard it is to react when you may know the person involved. Something that I have struggled with this week.

1. Wound Care : How to clean and dress the wound in a sterilized manner. 2. Venipuncture - or How to draw blood. 3.Inserting an IV cannula - To secure vascular access. This is one life saving skill. 4. Administering IM and IV injections 5.First Line treatment for Diarrhoea, Fever, Minor infections and dehydration. 6. Recognizing danger signs of sepsis (severe infection) 7.Preparing ORS - Oral Re-hydration Solution 8.Common Antibiotics, Painkillers and their dosage.

Well, the stuff you see after a disaster is completely different from what you see in the hospital. And like a wizard without his magic wand, you will be impotent without your MRI scanner and big operating rooms. EMT training is best for disaster aftermath. ATLS is crucial. ACLS is not as important, unless someone had a heart attack due to stress from the disaster, but ATLS would be the one to learn. Learn how to do triage, learn bio hazard and radiation hazard protocols. Learn how to detox people who suddenly do NOT have access to drugs or alcohol. An alcoholic or drug addict who suddenly does not have access will get DTs and die, or they might go berserk and start looting and killing to get drugs. This is a bigger problem than people realize. Think valium, clonidine, and methadone. Learn how to use them. Learn how to deal with rebound hypertension. People on high bp meds suddenly do not have them and their bp shoots through the roof. This is especially a problem if they were on beta blockers. How are you going to fix it? Sanitation. How will you secure sanitation? How will you prevent the spread of disease, particularly water borne disease? Those are the main issues.

In the US, you can get CPR/AED and First Aid training in a one-day session.  The next level would be Emergency Medical Responder (formerly "First Responder") training, which takes about 5 or 6 days and costs a few hundred dollars.  It covers more, including multiple-casualty situations. Anything higher than that - Certified Nursing Assistant, Emergency Medical Technician, etc. - takes weeks, costs more, and is aimed at people who are after a career. EMR training is pretty commonplace if you're in a job where keeping people safe and not-dead is somewhere far down the list of your duties.  I'm responsible for health and safety when managing an isolated facility, so I've been an EMR for 5+ years now.  My classmates have included rangers, interpretive guides, hotel security, etc.