• When the first responder is you

    When the first responder is you
    Illustrations by Sean Hudson; Diagrams by Mercé Iglesias
    Date:1 July 2011 Tags:, , , ,

    In an emergency, the first step is to call 10111, but the actions you take while professional help is on the way can mean the difference between life and death. Here’s how to step up from innocent bystander to instant hero.
    By Kalee Thompson

    Not as seen on tv
    The fireball:
    “On TV, when a car catches fire you usually get this huge explosion,” says ex-British Commando Paul Burton, a veteran of war zones and natural disasters. Reality is less dramatic: “When fire builds up pressure in the fuel tank, the valve shoots off and a jet of fuel comes out and catches fire, but the car won’t explode.”

    Save someone from a burning car

    It’s late, and you’re driving on a desolate highway. You see an orange glow in the distance – fire. Soon, you arrive at the scene. A car with a crushed front end has flames spilling from under the bonnet, and someone’s trapped inside. You dial 10111, and then…

    Create a safe zone, says Ron Moore, a fireman who has taught extraction techniques to first responders for 30plus years. Many people die every year because of secondary collisions. So block the site with your own car and switch on the hazard lights.

    Arm yourself with a wheel spanner and, if possible, a fire extinguisher, and don gloves and protective clothing.

    Walk– Don't run– towards the crash. Running can cause an adrenaline and endorphin rush, and kill clear thinking.

    Fight the fire. Stand uphill and upwind of the flames and discharge your extinguisher along the base of the fire. No extinguisher? For a small blaze, scoop up sand to snuff the flames. Above all, be realistic. “You don’t use a squirt gun to shoot an elephant,” Moore says.

    Gain access. If the doors are locked, smash the window furthest from the victim by striking it low in the corner with your wheel spanner.

    Free the victim. Normally, you shouldn’t move a crash victim, but if fire still threatens, hook your hands under his armpits, cradle his head and neck in your forearms, and gently drag him to safety. Keep the victim’s head and torso aligned as you move him, in case of a head or spinal injury.

    Bring a person to life

    For years, CPR instructors have drilled students with ABC: airway, breathing (mouth-to-mouth) and chest compressions. That approach got the boot last year, since the majority of adults who need CPR are cardiac victims, and studies have shown that they don’t need mouth- tomouth at all. A new, simpler method is designed to encourage anyone who witnesses an adult’s collapse to help immediately with hands-only CPR – chest pumps that keep blood circulating to the brain. (For a child or drowning victim, two breaths per 30 compressions are still advised.) No training is required, and good- Samaritan laws protect citizens trying to do the right thing. But once you start CPR, do not stop until the person stirs or professional help arrives.

    1 Cardiac victims may display seizure-like symptoms (fists clenching, arms straightening, and then fish-like breaths) before passing out. Immediately call 10111 if you see this, then begin CPR right away.

    2 Lift up the victim’s shirt, flatten your palms between his nipples and, with straight elbows, start pressing.

    3 Your palms should compress the chest cavity by one-third. Press rapidly: The recommended rate of 100 thrusts a minute just about matches the beat of “Stayin’ Alive”.

    Know your defibrillator

    For most victims of cardiac arrest, CPR serves only to keep blood flowing to the brain until help arrives. An automated external def brillator (AED) can jump-start a stopped heart. Now more common in public places, AEDs diagnose a patient before discharging and can guide a bystander through usage.

    Talk someone down from the edge

    Of the many suicides that occur each year, quite a few are jumpers. The sad truth is that timely intervention could have saved at least some of them. At San Francisco’s Golden Gate Bridge last year, there were 32 suicides – but at least 75 more were prevented by trained officers or alert passers-by. “If you encounter someone who is about to jump, the impulse is to become excited, to scream and run toward them,” says Eve Meyer, executive director of San Francisco Suicide Prevention.

    She advises approaching potential victims calmly and never reaching out to grab them, which could precipitate a jump. Instead, ask, “Are you okay?” and then “Will you walk with me?” Switching the focus to yourself is the key: “People in crisis will do a favour for another person, even though they won’t do something for themselves,” Meyer says.

    Survive a crowd crush

    “When a crowd starts to surge, it can collapse a concrete wall or easily push over a chain-link fence or other barriers you wouldn’t even imagine,” says James A McGee, a stadium security expert and former FBI officer who consulted for the 2004 Summer Olympics in Athens, Greece. Just two or three guys pushing unknowingly at the back of the mob can easily create a ripple effect that will knock people over – and if you’re inside the crush, you’re pretty much at the mercy of the surge. “You’re not going to be able to fight your way out,” McGee says.

    Instead, try to buy yourself as much personal space as you can by keeping your arms at your side, bending your elbows and pushing out. “People suffocate in that environment. They can’t even expand their lungs,” McGee says.

    Counter-intuitively, most crowd crushes occur when a mass of people is trying to get into a stadium, concert or store – not out. If you’re at the front of a line, scope out an exit path before the crowd starts to move.

    Avoid the surge
    Once you’re trapped in a crush, it’s difficult to escape, but if you sense that a crowd is getting dangerous, move perpendicular to the surge to reach the edge of the crowd.

    Protect your lungs
    The greatest danger in a crowd crush is compressive asphyxiation. Hold your arms akimbo to gain breathing room.

    Not as seen on tv
    The panicked public
    “Hollywood has a lot to answer for in terms of people running and screaming and crying (in a crisis),” risk and terror expert Dr Brooke Rogers says. In fact, people generally tend to remain calm, even in the face of disasters such as 9/11. “We call it the myth of the panic-prone public. Yes, some people get upset, but you find that the majority will try to comfort one another and cope together.”

    React to a home invasion

    Get out. If someone has broken into your house, your very best bet is to flee, according to Fred Mastison, president of Force Options, an Arizona-based tactical and self-defence training firm. Of course, that may not be possible if, for instance, you’re on the second floor or there are kids in the house. So Mastison recommends designating a “safe room” with a solid door, a deadbolt, a phone, a torch and tools to protect yourself.

    Once you're in the room, call 10111; stay on the line until help arrives. Let the intruder know you’re home by yelling that police are on the way. An estimated 86 per cent of home break-ins are robberies, many motivated by the need for drug money. Usually, criminals flee when they realise someone is home.

    Still, you must prepare for a violent confrontation, which is why Mastison teaches fighting and firearms skills. Using a gun for self-defence requires regular training and a willingness to use lethal force.

    Otherwise, arm yourself with pepper spray or a civilian Taser. “I’m not a big fan of impact weapons,” says Mastison, who advises against the use of baseball bats and knives: “They’re a lot harder than you’d think to use against a dedicated adversary.” The Taser, on the other hand, is a great tool: “Anybody and everybody can have a Taser now. I go through the Tasing as part of my training, and it is debilitating. I’m a big cat, and it stops me dead in my tracks.”

    Know your taser
    The civilian Taser C2 shoots electrode darts up to 5 metres. They transmit a high- voltage pulse to incapacitate an attacker. After the darts are ejected, the Taser can be used as a contact stun device.

    Survive a nuclear event

    Hopefully this section is on the outer fringe for South Africans, but here’s our advice, anyway. A modern nuclear disaster is less likely to come from an all-out nuclear war than from a powerplant radiation leak, like the one that resulted from the Japanese earthquake and tsunami, or from small-scale improvised “dirty bomb” weapons. If there is enough warning before an event, follow the evacuation instructions of authorities. But if a large-scale release of radiation has already occurred, stay put. Remaining inside a car for several hours could double your chances of survival; a windowless room inside a building is even better, and a basement is better still. “Go in, stay in, tune in” is today’s mandate in any sort of chemical, biological, radiological or nuclear attack, explains Dr Brooke Rogers, a lecturer in risk and terror in the Department of War Studies, King’s College London. Fight the instinct to find and meet up with family. Instead, follow these guidelines and know that you can’t feel, see, smell or taste radiation.

    If you are…

    Close all windows and turn off heat, air conditioning and ventilation. Go to the basement if you have one, as far away as possible from doors and windows. Cover your nose and mouth with a mask or cloth.

    Cover your mouth and nose. Remove your outer layer of clothing, avoiding pulling it over your head (cut or rip it if necessary). Find shelter quickly, and if possible rinse yourself with soap and water. Seek medical attention only if your wounds are lifethreatening; avoiding further exposure is your biggest concern.

    In your car
    Pull over, turn off the ignition and shut any vents that draw in outside air, including your aircon. Cover your mouth and nose and monitor the situation on your car’s radio.

    Escape from ice

    Irrelevent to South Africans? Think again. We know of two local anglers who go ice-fishing in various parts of the world year after year, and both have had near death experiences on thin ice. “People think that if you fall into ice water, you become hypothermic within minutes. This is incorrect,” says University of Manitoba coldwater survival expert Dr Gordon Giesbrecht, aka Professor Popsicle. “But if you think that, then you’re likely to panic, make bad decisions and die.” If you’re the one left standing after a friend plunges through the ice, you should stay put. You won’t be any help if you rush to the edge – and end up as a second casualty. If you have a rope or long branch within reach, you can use it to help pull your buddy to safety. Otherwise, you’ll have to talk him through selfrescue. Help him calm down by instructing him to take slow, deep breaths, and let him know he is not in immediate peril (it takes about an hour to lose consciousness from hypothermia). Once he’s calm, tell him to follow these steps:

    1 Place your forearms forward and flat on the ice edge, then kick your feet, which will create upward and forward bodily thrust.

    2 Keep kicking and move your weight forward on to your elbows as you shimmy your body up – very slowly and carefully – in an army-type crawl. Don’t give up if the edge breaks: just keep moving forward and repeating the motions until you reach solid ice.

    3 Once you’re out of the water, don’t stand up right away. Instead, roll away from the fissure until you’re on thicker ice.

    Find the strong ice
    Your best bet after falling through ice is to crawl out the way you came in – that’s the ice that has already supported your weight.

    Fight a fire

    A disturbing number of South Africans die in residential fires every year. The good news is that most house fires are put out before they turn deadly. To stay on the good side of the statistics, keep fire extinguishers in your kitchen and garage, and be sure every family member knows how to use them. If a fire is contained and the flames are no more than waist-high, fight it with an extinguisher. Keep your back to an unobstructed exit as you empty your canister, aiming at the base of the flames. Stop if breathing becomes difficult – most fire deaths result from smoke inhalation. If possible, close doors as you escape. And don’t risk trying to fight the blaze with the garden hose: it spews 50 litres a minute, in which time a firefighter’s nozzle blasts 900 litres.

    Know your extinguisher
    Fire extinguishers are rated: A (wood, paper), B (flammable liquids), C (electrical) or D (lab chemicals). Home extinguishers should be rated for all but D.

    10111 basics

    Use a landline. Home phones provide operators with your address; cellphones do not. If you must use your cell, tell the operator your location immediately.

    Stay on the line. Answer the operator’s questions succinctly, and don’t hang up until you’re told to do so or help arrives.

    Have a back-up plan. Put local police and fi re stations on speed dial.

    If you suspect a poisoning, call the poison hot line listed in the front of your phone directory. Call 10111 only if a poisoning victim has passed out or is having a seizure or difficulty breathing.

    Know when not to call 10111. It’s for real human emergencies. Cat up a tree? Call your town’s general information line. Actually, you can go one better: the front of your phone book lists all or most of the direct numbers for emergencies. Tape a list of these numbers beside your phone.

    Save a drowning victim

    Dozens of South Africans drown in a typical year, some of them while trying to save someone else (this usually happens at sea). “Just because someone is a good swimmer does not mean they are capable of safely performing a rescue,” says Bill Humphreys, who has performed about 1 000 ocean saves in his 34 years as a California lifeguard. “Even a professional doesn’t just run out into the water; the first thing he does is call for backup.” Then he grabs a rescue buoy or tube; for nonpros, a surfboard, a life jacket or anything else that floats will suffice. If you’re the rescuer, swim out to the victim and hand over the flotation device without letting him grab you. “If you’re a good swimmer, in flat water a small child is not going to take you under,” Humphreys says. “But even teenagers, when they’re panicked, will be fighting for their lives – and cling to and climb up on anything to get their head above water.” If you put yourself within reach, that anything will be you. So let the victim get a hold of the piece of rescue equipment, then calm him down and begin paddling for land.

    Not as seen on tv
    Flailing drowning victims

    “People waving for help, yelling and thrashing around in the water – that’s what you see on television,” Humphreys says. Actual drowning is much more subtle: “The head is low. He might even be looking upward a little bit in an attempt to keep his mouth out of the water. Quite often his arms aren’t above water, because he’s too busy trying to use them to stay afloat.”

    Surviving a building collapse

    A fallen building, common after an earthquake, is extremely unstable. Whether you are trying to escape or free someone else from the wreckage, move carefully. If you find someone pinned under the rubble, first calm the person down – then start figuring out what you can use for leverage to free them. “Whatever’s pinning them, you’ll need to move it only a couple of centimetres before you can slide them out,” explains retired firefighter John O’Connell, who responded to both the Oklahoma City bombing and New York’s Ground Zero and is president of the training facility Collapse Rescue Systems.

    “But you still have to be extremely aware, as you pry up on anything, so you don’t disturb the pile and cause a secondary collapse. That’s the biggest killer of rescuers.” Time is also critical: if you don’t free a badly injured victim in roughly the first hour, crush injury syndrome (kidney failure due to damaged muscle tissue in the bloodstream) comes into play. “If after six hours you free them and there’s no medical aid, they’re probably not going to survive,” O’Connell says. Once you free your victim, keep him alert and give him water. If you’re trapped in the structure, yell or bang on a pipe to alert rescuers, and be methodical. “If you just start smacking some crap around, they may think it’s falling debris,” O’Connell says.