ASHI and MEDIC First Aid Blog

August 27, 2019

Lessons from the First There, First Care Era

By guest blogger Bill Rowe, Director of Content Development

In 2003, the U.S. National Highway and Traffic Safety Administration (NHTSA) initiated the First There, First Care campaign to promote bystander emergency care in relation to motor vehicle crashes.

This seemed a reasonable follow-up to the work NHTSA had already done in helping to establish modern EMS decades earlier, based on the 1966 U.S. National Academy of Sciences report, Accidental Death and Disability: The Neglected Disease of Modern Society.

First There, First Care contained the first training materials I ran into that were focused on simple cognitive concepts for untrained bystanders at emergencies. Today we recognize a similar approach with programs for bystander compression-only CPR and bleeding control. The most current iteration of First There, First Care now resides with the U.S. Department of Homeland Security (DHS) in their much more broadly applied Until Help Arrives.

First There, First Care attempted to reduce the complexity of emergency care by focusing on the things that could make the most difference in the first few minutes of an emergency. It was fundamentally based on the idea that a bystander could take a few simple steps to ensure a better outcome. It also took as a given that EMS response and care was involved.

To be sure, immediately life-threatening emergencies were emphasized because surviving those was completely dependent on who could provide care, prior to the arrival of EMS. First There, First Care highlighted medical care such as “Start the Breathing” and “Stop the Bleeding” in response.

However, in doing the initial NHTSA research to figure out the most important concepts to train bystanders in, some interesting things emerged. Immediate life-threatening problems were a priority for sure, but they were not present in all emergencies.  As it turns out, much more basic things, common to all emergencies, actually contributed the most to improving the overall effectiveness of the help provided. In general, they relate to how an emergency is managed and not to the specific care provided.

Here they are:

Recognizing an Emergency - By their very nature, emergencies are unexpected and confusing. It’s easy to pass an emergency scene without getting enough information to fully understand what’s going on. Suspicion plays a vital role in recognition. Important concepts such as forming a general impression of what’s going on and looking for possible mechanisms for serious injury can help to quickly build suspicion about what happened.

Deciding to Help - It is normal for someone to feel hesitant about helping in an emergency. Maybe the problem is too big to handle. Maybe he or she has anxiety about his or her abilities. Maybe if someone screws up, the person trying to help will be sued for negligence. There are a lot of reasons to not get involved. By clearly defining the role of the first aid provider, the limited “do no harm” skills they are trained in, and the supporting influence of an effective EMS system, these fears can be directly addressed in training.

Personal Safety - If something bad happened to another person, especially when injured, it can happen to a bystander trying to help. Becoming another victim at an emergency scene complicates things significantly and diminishes the level of care that can be provided to anyone. Understanding the ultimate priority of personal safety, and taking steps to ensure it, are essential in an emergency. Similarly, protecting ourselves from infectious disease, transmitted by exposure to blood or other potentially infectious body fluids, is an active, deliberate, and recommended action to take.

Calling for Help - How hard can it be to call 9-1-1?  Surprisingly, there is plenty to go wrong here, too. In a caller’s rush to get help coming, emergency call takers may not get all the information they need for an efficient EMS response. Most EMS systems are designed to take charge of an emergency call as much as possible and it’s essential for anyone calling to let them do so. Answering all questions clearly, in the order asked, is important. The ultimate rule-of-thumb of hanging up last on an emergency call is a simple and effective tool to remember.

If there is little effort applied to these things in an emergency, it’s likely to lower the chance that someone will become involved or be helpful on an emergency scene.

These steps have a lot of influence on how well an emergency is managed. A lot.

This not only applies to the bystanders on the highway in the NHTSA world, but to all emergency medical care providers, including your students in CPR and first aid.

As an instructor, the challenge to you is to not only think about how your students can perform certain skills such as CPR or the control of bleeding, but how prepared they are to generally manage a medical emergency, especially at the beginning.

Many of you have probably noticed the connection of these things to the front end of our core ASHI and MEDIC First Aid training programs. The First There, First Care NHTSA research was influential in our instructional design, and lessons are dedicated to each of the concepts outlined above. This allows you to establish reassurance, confidence, and a basic approach to emergencies early in the training process. 

In addition, we provide scenario sheets for optional practices, which allow you to let students manage simulated emergencies from start to finish. Feel free to modify the scenarios to reinforce important concepts, such as letting a student provider meet the same unfortunate fate as an ill or injured person because they failed to identify a dangerous scene.

Overall, don’t underestimate the importance of these things to a student down the road when they come face-to-face with an unexpected emergency. Someone with incredible CPR and first aid skills doesn’t help at all, if he or she never gets involved in the first place.

Interested in a career teaching these simple, lifesaving skills to your communities? Click the button below to download our Getting Started in Emergency Care Training eBook to learn how you can make a difference with ASHI and MEDIC First Aid.

Download Getting Started in Emergency Care eBook




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