A life-threatening emergency, involving the failure of breathing, circulation, or rapid blood loss, demands immediate and decisive action. Bystander intervention can bridge the gap until emergency medical services (EMS) arrive. Preparation and quick action are the most effective tools for increasing survival. Understanding the correct sequence of response is paramount.
Establishing Safety and Activating Emergency Services
The first step in any emergency is ensuring the safety of the rescuer, the victim, and any bystanders. Quickly scan the area for hazards such as traffic, downed power lines, or fire. Do not attempt a rescue until the scene is reasonably secure.
Once the scene is safe, check the victim for responsiveness by gently tapping and shouting, “Are you okay?” If the person is unresponsive and not breathing normally, activate EMS immediately by calling 911 or the local emergency number. If another person is present, instruct them to make the call and return with an update, allowing you to begin immediate care.
When speaking with the dispatcher, remain calm and provide specific details: your exact location, the nature of the emergency, and the number of people injured. Stay on the line and follow the dispatcher’s instructions, as they are trained to guide you through lifesaving steps. If contact with blood or body fluids is anticipated, consider wearing gloves or using a makeshift barrier.
Addressing Immediate Airway and Breathing Failure
The most common life-threatening emergencies involve the failure of the heart or lungs, often necessitating immediate Cardiopulmonary Resuscitation (CPR). For an unresponsive adult not breathing normally, untrained bystanders should initiate hands-only CPR, focusing solely on chest compressions.
To perform hands-only CPR, place the heel of one hand in the center of the chest, between the nipples, and place the other hand on top. Push hard and fast, compressing the chest at least 2 inches (5 centimeters) deep, but no more than 2.4 inches (6 centimeters). Maintain the compression rate at 100 to 120 compressions per minute.
If an Automated External Defibrillator (AED) is available, retrieve and apply it quickly, as defibrillation is the definitive treatment for certain cardiac arrests. Power on the device and follow the prompts, ensuring the pads are placed correctly on the bare chest. The AED will analyze the heart rhythm and advise whether a shock is necessary.
Airway obstruction, or choking, requires the Heimlich maneuver (abdominal thrusts). If a conscious adult cannot speak, cough, or breathe, stand behind them and wrap your arms around their waist. Make a fist with one hand and place the thumb side just above the navel. Grasp the fist and deliver quick, forceful inward and upward thrusts to expel the object.
Controlling Severe Hemorrhage
Uncontrolled external bleeding can lead to death in minutes, making hemorrhage control a high priority. The first method for severe bleeding is applying firm, continuous pressure directly to the wound using any clean material available, such as gauze or clothing. Maintaining this pressure is essential.
If direct pressure is insufficient, or if the wound is deep, the next step is wound packing. Tightly pack the cavity with clean material and then apply firm pressure directly over the packed material. Do not remove material once it is placed; simply add more material on top and increase the pressure.
When bleeding is catastrophic, such as from an amputation or a wound that cannot be compressed, a tourniquet must be applied to the injured limb. Commercial tourniquets are preferred. Place the tourniquet high and tight on the arm or leg, two to three inches above the wound but not over a joint.
Tighten the tourniquet until the bleeding completely stops, securing the mechanism to prevent loosening. Restricting blood flow is necessary to save the person’s life. Note the time the tourniquet was applied, writing it on the device or the person’s forehead, as this information is needed by medical professionals.
Sustaining Care Until Professional Help Arrives
Once immediate life threats have been addressed, focus shifts to sustained care while awaiting EMS. Continuously monitor the person’s condition, routinely checking for consciousness, breathing, and circulation. Be prepared to restart CPR or re-tighten a tourniquet if the person’s condition deteriorates.
A common complication after severe injury or illness is medical shock, which occurs when the circulatory system fails to deliver enough oxygenated blood to the body’s tissues. Symptoms of shock include pale, cool, or clammy skin, a rapid or weak pulse, and fast, shallow breathing.
To manage shock, lay the person down on their back. If no head, neck, or back injury is suspected, elevate their legs about 12 inches to improve blood flow to the core organs. Keep the person warm by covering them with a blanket or coat, as preventing body heat loss helps manage shock. Do not allow them to eat or drink.
When professional responders arrive, provide a concise handover detailing what happened, the care provided, and any observed changes. Good Samaritan Laws exist in most jurisdictions to encourage bystanders to intervene without fear of civil liability, protecting individuals who provide reasonable assistance in good faith.