In first aid training, it should be drilled into students more and more that Danger is the No. 1 consideration for First Aiders. It's often mentioned, but the massive importance of the issue is not always effectively addressed. Personal safety and personal protective equipment should be dominant factors in your decision-making process of, ‘To help or not to help!’ The tough reality is that if you're going to be at risk, then you always have the choice not to involve yourself. It's a hard decision, especially when you're trained and have a desire to help others, but sometimes it's the only choice possible if you’re going to end up in danger yourself.
One situation I found myself in where the danger to me proved far too great, was when I was in Colorado, in the US. I was skiing at Breckenridge, and coming down a home trail that links two of the peaks together, when a movement out of the corner of my eye caught my attention. I skidded to a stop. Glancing back I saw two figures scrambling desperately to get out of a creek bed next to the trail.
The first one popped up onto the side of the track. ‘Are you ok?’ I asked, seeing that he was a snowboarder.
‘Yeah, I'm fine,’ he panted.
He seemed distracted, turned back and scrambled towards the creek. I skated up and took a closer look. I could see his friend half way up the snow covered embankment, his head covered in blood.
‘Oh…’ I thought, suddenly switching modes and quickly assessing the area, the people and everything around me.
The guy who'd climbed out first was now becoming increasingly distressed.
I looked directly at him and calmly said, ‘Would you like me to call ski patrol?’
‘Oh yeah man… yeah… I need to get him out!’ he replied sounding confused and now appearing disorientated.
That was about the best indication I could get that this guy wanted help, so I called ski patrol and gave them a quick description of the situation and my location. At this point however, I’d only just seen the scrambling up, some blood and heard a bit of noise. I didn't quite understand the full extent of the injuries or anything like that.
As I got off the phone, I could see the second snowboarder grab the edge of the track and push himself up. I clicked out of my skis and stepped forward. Staggered to his feet, the snowboarder stumbled toward me. Taking one look, I stepped back. Blood was pouring down his face like a bubbling brook.
Taking another defensive half-step back I said, ‘My name’s David, I’ve called ski patrol and they're on their way.’
I got a mumbled somewhat confused response that at some point included an acknowledgement.
This whole time, I was still assessing the scene and evaluating the injured snowboarder. I'd determined the scene was safe. Given the mechanism of injury appeared to be snowboarding into a creek without a helmet, I wasn't that concerned about that happening to me. The next danger was that the snowboarder was now standing in the middle of a ski run and other skiers and snowboarders were riding past at speed. To manage this danger, after I took my skis off, I’d crossed them up hill from our location, so I was happy with the fact that I wasn't going to get hit where I was standing.
Next I moved to the human factor in my ongoing Danger assessment. I’d already determined that there was significant personal risk involved in providing First Aid. There was blood everywhere, I didn't know the person, he appeared to be under the influence of drugs and I had no personal protective equipment (gloves). This was too much danger for my liking and there was no way I was going to put myself at risk of a blood borne infection through providing assistance in this situation. At the same time, I also decided that I wasn't going to just walk away. I was going to be entirely ‘hands off’ as the casualty was at least able to do things for himself and help was on its way.
From a safe distance, I provided clear instructions to him and his friend, who was still wandering around in a panic. ‘Okay, ski patrol isn't far away,’ I said again to reassure the casualty. ‘What I suggest you do whilst you wait is just sit down on the side of the track and with your glove, press down on your head.’ I pointed to where I wanted him to sit, out of the way of others and demonstrated with my hand on my head to show him what I wanted him to do.
The blood kept streaming down the snowboarder’s face unabated, but there was little else I could or would do in this situation. He sat down and at least put some pressure on his wound. For at least 2 minutes, he was sitting there doing what I'd suggested he do.
This is where it became weird. His friend is still walking about in a panic and I was trying my best to calm him and reassure him. Then the casualty starts reacting to his idiot friend’s panic. ‘I've gotta get outta here man!’ he said.
‘Oh no,’ I thought. ‘Here we go!’
Now dealing with profusely bleeding drug tripping snowboarders isn't my idea of a good day on the snow, but I still had to try my best until I could hand this bloody mess over to ski patrol.
‘It's okay,’ I said again, ‘ski patrol is on its way. Just stay where you are, keep pressure on your head and you’ll be taken care of shortly.’
‘Nah, man I gotta go!’ he said, taking his hand off the head wound. Suddenly more blood streamed from his head as the pressure released. He proceeded to strap on his snowboard.
I tried reasoning with him some more, and when that didn't work, I tried reasoning with his friend. Not an easy thing to do with stoners! Dave definitely wasn't their man!
No matter what I tried, the guy was determined to go, so I certainly wasn't going to try and stop him. He skated off woosily, his friend chasing after him yelling, ‘You gotta see a doctor man!’
I quickly got back on the phone to ski patrol and explained the situation. ‘Do you know where he’s going?’ they asked.
‘No, sorry I don't know, but there's a pretty clear trail of blood leaving my location. Follow that and you're bound to find him.’
With that, it was the end of my involvement. Even though I provided some level of assistance, I remained completely hands off to protect myself from the clear and present danger. Having come across an injured person, I’d fulfilled my obligations under the skier’s code of responsibility, by stopping and calling ski patrol. However, in my assessment of the scene, the injury and the person involved, I’d decided very quickly during my initial danger assessment, I wasn't going to offer or provide first aid.
This can be a hard decision, as you're trained to help others in need. However, I've seen people rush in to situations and end up finding themselves covered with a stranger’s blood, which, even if you've only got a paper cut on your finger, could mean an infection. The last time I saw this happen, the person was a first responder to a car accident. He rushed in with another, started treating a casualty, no gloves, no danger assessment done at all. The irony was that there was a well-stocked First Aid kit with plenty of gloves in the back of the responder’s vehicle. If they had taken 60 sec to calm themselves, checked for dangers and put gloves on whilst they assessed the scene and its surrounds, they wouldn't have needed to go through the stress of a number of blood tests for infectious diseases. I can't stress enough DON’T DO THIS! If you're the first responder, your No. 1 priority is always to CHECK FOR DANGER! At the end of the day, you can't afford to put yourself at risk of harm and become the second casualty of the incident.