First aid: No magic, only skill, will and a piece of cloth
Doctors in Jammu and Kashmir are taking time away from their hospitals to strengthen their first aid skills to save lives on the roadside. They have the support of the health authorities and the ICRC.
“The feeling one has of one’s own utter inadequacy in such extraordinary and solemn circumstances is inexpressible.”
Henry Dunant, 1859, Solferino battlefield
As she stepped out of the hospital, a loud bang went off.
What followed would leave Dr. Bindu Chauhan shaken for the next eight years. Blood was spattered everywhere. The place was strewn with tattered clothes and severed limbs. All around her were casualties with splinter wounds.
"I saw two injured people breathing their last breath before my eyes as I stood, a mute spectator to the trauma and pain that the blast victims were going through. I have never found myself so helpless,'' recalls Dr. Bindu, a doctor at Kathua District Hospital in Jammu and Kashmir.
It was not the images that shook her but the same ‘utter inadequacy’ that Henry Dunant felt 150 years ago.
That shock and helplessness prompted Dr. Bindu to participate this year in a six-day course on basic lifesaving and stabilizing measures, along with 40 of her colleagues from across Jammu and Kashmir. The course focused on how to respond to emergencies caused by road accidents or situations of violence, like what she had witnessed, by treating bleeding, fractures, burns, etc. with limited means. The course’s aim was also to transfer the skills taught to as many people as possible.
For Dr. Masood, another participant, the course will have a ripple effect.
But do doctors need to be trained in basic lifesaving?
Dr. Bindu believes that the majority of doctors may not necessarily know how to cater to emergencies outside of an equipped hospital. Those without basic first-aid training often find themselves unable to provide adequate care in such situations. "In a place like Jammu and Kashmir where uncertainty is the only certainty, basic knowledge of first aid for medicos is a must", she recommends.
The ICRC's Geneva-based coordinator for emergency pre-hospital care, Dr. Eric Bernes, who was in India to conduct the training, adds that sometimes all the medical knowledge can be an obstacle because it applies to a specific working environment with ready access to colleagues and equipment. First aid prompts medics to return to basics and rediscover their skills to deal with emergencies, but without resources and with the help of bystanders at the scene. "Hands, the brain and a desire to provide help in a safe manner are all they need", says Dr. Bernes. For him, training isn't just about rediscovering skills but also "revisiting that humanitarian attitude, how to talk to the wounded and people around, and give that psychological support during first aid."
Need for emergency responders
Aware of the need for skilled emergency responders in the state, Jammu and Kashmir health authorities have initiated a holistic approach to the care of casualties. The aim is to improve the people’s capability to save lives, right from the site of the incident to the hospital. This drive to strengthen emergency-response capacities got a boost in 2011 when the Directorate of Health Services initiated a series of training courses for its medical staff. The ICRC lent its technical support to the initiative. However staff training was not an end in itself. In the last two years, the medicos who received training have themselves trained over 4,000 people, primarily hospital staff, who are likely to be first responders at the site of emergencies like accidents and violence. The likely first responders include journalists, ambulance drivers, soldiers, Red Cross volunteers, the youth and community members.
The first responders are trained to treat casualties with whatever resources are available on the spot, which, Dr. Bernes believes, “empowers them to come forward, save lives in difficult situations, gain respect in the community in the process, and even mobilize community members or earn their support."
But the management of emergency response does not end at the roadside. It must follow the patient - from the site of the incident to the hospital. Experts and practitioners suggest that while first aid is one vital aspect of lifesaving, emergency-room trauma care is the other.
Two police surgeons who participated in the courses told the ICRC that they often received patients in police hospitals who could have been saved or treated more effectively had they received adequate first aid. On the other hand, once a trauma patient arrives at the hospital, proper diagnostics and therapeutic procedures in the emergency room play a determining role in reducing trauma-related death, says ICRC consultant surgeon, Dr. Asa Molde.
Emergency room trauma course
Bearing in mind the complementarity between first aid and medical treatment, the Directorate of Health Services for Jammu and Kashmir and the ICRC came together to conduct an emergency room trauma course (ERTC) for medical staff managing trauma cases.
ERTC is an advanced course on life support and trauma management that enables doctors to establish a simple, systematic and concise approach to the early care of trauma patients in emergency units. In April 2013, 20 medics from Jammu and Kashmir, including anaesthetists and orthopaedic surgeons, received theoretical and practical training in Srinagar on airway and ventilation management, and the treatment of head, spinal and limb injuries, etc. This was followed by simulated exercises.
"The beauty of this course lies in its participatory methodology and optimal use of limited resources," said participant Dr. Iqbal Ahmad, an anaesthetist. ERTC has enabled Dr. Tabassum, an orthopaedic surgeon, to follow a systematic protocol while examining patients. "This way we are unlikely to miss injuries which could prove fatal if not diagnosed and treated on time", she says.
Professor Pampori, principal of the Government Medical College that organized basic training on lifesaving and stabilizing measures, in Srinagar this year, believes that not only will courses like these “strengthen people’s capabilities, but in addition, the collaboration between the College and the ICRC will be mutually beneficial and foster future cooperation”.
It was first aid on the battlefield of Solferino, 150 years ago, with Henry Dunant as the world’s original first aider, that brought forth what we know as the ‘Red Cross’. With every wound healed and every life saved as result of such courses, we go back to the roots. We are reminded of the raison d’être and continued commitment of first aiders to help save lives in emergencies through neutral and impartial humanitarian action.