Dealing with Mass Casualties - Triage First Aid

You Don’t Have to be a First Aider to be a First Aider …

Terrorist attacks for the majority of us will remain an atrocity that we will only hear about or see on the news.  When there are many casualties we need to apply the principles of triage first aid. Should you ever find yourself as a bystander and survivor, even with absolutely no first aid training, here’s what you can do to be a life-saver.
  1. Assess the situation – is it safe?

    If it’s not safe to be there – run away. If running away isn’t possible then hide. Either way don’t make yourself a casualty: you’ll be no good to anyone.

  2. Airways

    Before you even call 999 quickly sweep through all the casualties and roll anyone that is unconscious onto their side. Don’t worry about other injuries or how you do this – just get them on their sides so that they have stable open draining airways. Doing just this gives them every opportunity to breathe. If there are other passers-by that are able to help, order them to do likewise.

  3. Phone for help

    If nobody has yet called the emergency services you should do so now. Chances are – they have.

  4. Shock management

    Now turn your attention to dealing with blood loss. Anyone that is able to help you, tell them to find bleeding casualties and to apply pressure to the wounds with anything they can find. Since the 2013 Boston Bombings tourniquets have also been brought back into first aid training; but only as a last resort. Tourniquets can only be used on limbs and only if the bleeding is so heavy that the casualty is likely to die within the next few minutes. If you have to tie a tourniquet to a casualty you are in effect consigning their lower limb to amputation. But for casualties who have already lost a lower limb for example, a tourniquet will be a life-saver.
    Tie a tourniquet using anything that you can improvise with. This might be the shirt off your back, the sleeve of a jacket or a spare inner tube from a cyclist. As a first-aider using an improvised tourniquet you will be flapping and in a panic. To be sure to get the desired result as soon as possible, tie it to the upper limb (above the knee or elbow) as tight as you can. Keep tightening until the bleeding stops or you can tighten it no more. If you have the presence of mind to do so, mark the casualty’s face with a T and the time that the tourniquet was applied. Keep it applied: it will only be a medic who should undo this.

  5. Managing the walking injured and people in panic

    Sight an obvious landmark that is in a relatively safe space. Anyone that can’t be of assistance should be directed to that place and told to wait there. Obvious land marks like a phone box are ideal – but also try not to block access for the emergency services who are likely to be there soon. Once the emergency services are there find a casualty who is not receiving medical attention and simply talk nicely to them, and reassure them that they will be ok.

  6. Take care of yourself

    Post traumatic stress disorder (PTSD) is a very real thing. It doesn’t have to be a mass casualty situation – it could just be a near-miss. Different people respond in different ways. If you are involved in a situation such as this remember to take care of yourself. Don’t go through the what ifs – it’s not healthy for you or helpful. Give yourself a pat on the back for getting stuck in and do seek help. You will need it.

Will Legon works professionally in the outdoors guiding and instructing, walking and climbing in the hills and mountains of the UK and beyond. Since 2009 Will has been delivering first aid training for all work place environments but specialising in outdoor first aid courses. He is an ITC (Immediate Temporary Care) trainer, offering a range of courses accredited by Ofqual and the SQA. In a former life, Will was a maths teacher and an infantry officer in the Territorial Army.