By Chief Rob Wylie (ret), BS, EMT-T, EFO
What is a resilient community? According to the Community & Regional Resilience Institute, resilience is “the ability to anticipate risk, limit impact, and bounce back rapidly through survival, adaptability, evolution, and growth in the face of turbulent change.”
As a 30-year veteran of the fire and emergency services, the holy grail has always been for me to assist the communities I served to become resilient. This means to prepare for natural disasters such as tornadoes, floods and fire; to have individuals and groups (neighbors) can stand on their own for a period until the fire department can get to them, especially during a disaster.
To that end, we have spent countless hours and hundreds of thousands of dollars training people in CPR and basic first aid. However, the underlying premise had always been, “We (the fire department) are coming, and when we get there, get out of our way.”
Response time reality
The issue with this concept that if someone just calls 911, then a police officer, firefighter or medic will magically appear and solve my problem, is that it really doesn’t work that way.
During a recent class I taught, attendees were asked, “What do you do in an emergency?” The answer was unanimous – call 911.
When the same group was asked, “How long do you think it will take a responder to get to you after you call 911?” The most popular answer was five to seven minutes.
The issue that we overlook is that it takes as little as three minutes to bleed to death from a traumatic injury. It takes time for responders to be notified and to make their way to the scene of the emergency. When someone is dying, time is a matter of life and death.
While five to seven minutes is certainly an acceptable response time for emergency responders in many communities, in other communities – like Barrow, Alaska, where my colleagues and I recently taught a First CARE Provider class – the response time could be hours or days depending on such variables as weather and distance. The North Slope Fire District is responsible for over 90,000 square miles.
And while Barrow, Alaska represents an extreme example of prolonged response times for emergency responders, in fact, even in a metro or suburban area response times can vary greatly depending on the scope of a disaster, the number of emergency calls resulting from that disaster and the number of responders available at any given time.
The International City Managers Association set the acceptable rate of emergency responders at about one responder for every 1000 residents. That translates to very few responders when a major incident like a tornado or a hurricane occurs.
Hundreds of hours and thousands of dollars are spent training people in CPR, how to use and automatic external defibrillator and basic first aid.
An American Heart Association report suggests the incidence of out-of-hospital cardiac arrest is 326,200 annually. The average survival rate is 10.6 percent and survival with good neurologic function is 8.3 percent.
Compare those statistics with those that list trauma as the number one cause of death in people between the ages of 1-45 years of age, with an economic impact annually of 400 billion dollars, of which 20 percent are survivable with proper intervention and you are looking at 30,000 lives saved annually.
Stop the bleed
Uncontrolled post-traumatic bleeding is the leading cause of potentially preventable death among trauma patients.
In fact, if proper interventions are done within the first three to five minutes for such injures as critical bleeding, there is a 90 percent chance that the injured person will survive. With that in mind, we get a much bigger bang for the buck teaching civilians to use tourniquets than we do teaching CPR.
Before you vehemently disagree with this notion, I fully support teaching CPR. It saves lives. But a broader, more comprehensive approach is needed.
To build truly resilient communities though, we must first dispel the myth that emergency responders will solve all our problems. We must acknowledge that for the first five to seven minutes in an emergency the true first responders are the people who are present at the time of the incident.
Teaching those First Care Providers to deal with traumatic injuries such as critical bleeding will save lives and empower those who receive the training to make a difference rather than just calling 911 and hoping help arrives in time. Hope is not a plan.
I am not advocating that people sitting at home see or hear a story about a bus accident and leap from their chairs to go render aid. I am advocative for teaching the people who may be on that bus sitting next to their child or spouse or friend to act and to save that loved one’s life.
We, as emergency responders, must get past the idea that we are the only ones who can help in these situations. Civilians with a modest amount of training can make a difference when it comes to traumatic injuries such as critical bleeding (tourniquets and wound packing), airway obstructions (recovery position) and breathing problems resulting from trauma (chest seals).
Through a series of exercises held during First Care Provider training sessions we have found that average people with as little as a half day of training are almost as effective as trained responders in recognizing critical issues like bleeding, and intervening. See below figure.
- (Trained) = Civilians who have completed First Care Training
- (Untrained) = Civilians before any training
- EMS = Trained EMT’s, Paramedics and RN’s
Shifting the paradigm
To be a truly resilient community, we much teach people how to rely on themselves in the first five to seven minutes. Every minute that passes makes a difference between life and death.
First responders must teach and educate their residents to be force multipliers instead of unlucky bystanders that need to be moved out of the way during an emergency.
As emergency responders, we must pop the illusion that we will always be there in time to make a difference. We must acknowledge and prepare of citizens for the reality that in a time of a wide spread crisis like an earthquake, a tornado, severe weather or agencies with large areas to cover and not enough resources to cover them all in that five to seven minute window.
Let’s educate our communities that with a modest amount of training, individuals who are present during a time of crisis can provide meaningful and effective care.
About the Author
Robert B. Wylie
Chief Wylie has been in the fire service for 30 years serving first as a volunteer firefighter and then as a career firefighter, rising through the ranks to become the Fire Chief of the Cottleville FPD in St. Charles County, MO in 2005. He is a graduate of Lindenwood University (84’) The University of Maryland Staff and Command School (96’) and the National Fire Academy’s Executive Fire Officer Program (2000).
During his tenure, Chief Wylie has served as director of the St. Charles/Warren County Haz Mat Team, and President of the Greater St. Louis Fire Chief’s Assoc. He currently serves as the President of the Professional Fire & Fraud Investigator’s Assoc. Additionally he has been an appointed member of the Governor’s homeland security advisory council, and is a current board member of the State of Missouri’s Fire Education and Safety Commission as well as immediate past Chairman of the St. Louis Area Regional Response System (STARRS). Rob has served as a Tactical Medic/ TEMS Team Leader with the St. Charles Regional SWAT Team for the last 20 years and serves on the Committee for Tactical Casualty Care’s Guidelines
Chief Wylie will be presenting at our 2018 Conference.