There are things that kill you instantly, like a bullet to the head or a fall from twenty stories. First aid can’t help you there. There are also things that kill you relatively slowly, like a bacterial infection. If you have even hours to live, you can get to the emergency room.
But there is a small class of things that will kill you in minutes unless someone comes to the rescue. There isn’t time to get to a hospital, there isn’t even time for help to arrive in an ambulance. There is only time for someone already on the scene to provide emergency treatment that either solves the problem, or stabilizes you until help arrives. Here, first aid can be the difference between life and death.
Not long ago I became a father. Being responsible for the life of someone so helpless and vulnerable spurred me to finally take first aid training, including CPR. Here’s what I learned from that experience, and what I think everyone should know about first aid.
What most of the things that kill you quickly have in common is that oxygen can’t get to your cells. If you are choking, oxygen can’t get in. If your heart stops beating, blood doesn’t flow. If you have a severe wound, you’re losing that blood rapidly. If any link in the respiratory-circulatory chain is broken, your cells are starved for oxygen and you have minutes to live.
The key first aid skills follow from this: CPR manually substitutes for heart and lung action; the Heimlich maneuver expels an object from the airway; a tourniquet stops life-threatening bleeding (on an extremity, at least—if the wound is elsewhere, there is a different technique, known as packing the wound).
The basic skills are remarkably simple. The course that I took was only a few hours of online instruction, followed by about an hour of in-person demonstration and practice with dummy patients. And I went through a lot of the optional material, including things like stroke, fainting, and jellyfish stings. I’m sure I’m nowhere near as good someone with more professional training or experience, but an introductory course is not daunting.
The most important thing I learned is that if you find yourself in an emergency situation, it is better to do almost anything rather than nothing. Again, if someone stops breathing for any reason, they have only minutes to live. They are dead by default, unless someone intervenes. There is very little you can do to them that is worse than cutting off their oxygen.
In fact, it is probably better to attempt CPR or the Heimlich maneuver than to do nothing, even if you have never been trained and are only guessing, or mimicking what you have seen on television. The skills were fairly unsurprising to me and were consistent with what I expected prior to training. This does not mean that you don’t need to bother with the training, and of course if someone trained is on hand then let them take over. But don’t let the bystander effect paralyze you if someone’s life is ever in your hands.
In fact, the American Heart Association promotes a form of CPR called “hands-only,” in which you only do chest compressions, without giving breaths mouth-to-mouth. Their instructions for this are: “push hard and fast in the center of the chest.” That’s about it. if you only know that, you can do better than nothing.
Similarly, if you can find an AED machine (automated external defibrillator), you do not need training to use it. The instructions are literally: open it and follow the prompts. The parts are clearly labeled, and there is a voice recording that walks you through every step of the process.
In the end, the biggest thing I gained was the confidence to act.
I made an Anki flashcard deck for the course and have been using it to keep my memory fresh. If you do a similar course, you can download my deck from AnkiWeb.
I took an emergency medical response course in college (~40 hours, all in-person, with a mix of verbal lessons and practical exercises in each class), and the most important thing I learned was that having memorized what to do in an emergency is not sufficient to get you to actually act. [ETA: Also, to call 911 in an emergency!]
I got 100% on the written test and still remember much of it to this day, but I am an absolutely terrible person to go to in an emergency because I panic and freeze every time. I've seen this play out in myself many times over my life, not only when witnessing real falls, car accidents, and other incidents, but even in the practical exam for the course. The exam involved diagnosing and describing the treatment for instructors acting out different emergency scenarios, and while there were other contributing factors, ultimately the fact remains that I got 0% on the practical and failed the course because I had a panic attack and had to leave.
Knowing how to do chest compressions on a dummy is better than not knowing how to do that. But doing chest compressions on a dummy is extremely different from being faced with an unresponsive person, knowing that they'll die if you don't act, and knowing that even if you successfully save their life, administering CPR means a good chance of breaking some of their ribs. It's better to know how to drag someone out of a burning building than to not know, but dragging an unconscious person through a smoky inferno is going to be different than doing the same motion in a brightly-lit classroom with a conscious and cooperative partner, where there are no real stakes for messing up.
On balance I'm still glad I took the course. But I caution anyone against thinking that just studying flashcards is sufficient preparation for real-life emergencies — at the very least, take a class like Jason did, with some in-person practical components.
In addition to training, Leo Prinsloo mentions the value of "pre-visualization" in this video. Could work well with Anki cards -- don't just review the card, pre-visualize yourself putting the steps into action so it becomes automatic under pressure.
Calling 911 or your local emergency number is also a good default action because the call taker should be trained to walk you through some of the things the post described.
Don't be afraid of creating duplicate 911 calls for something like a big fire or car crash. Merging duplicates and rapidly closing out unnecessary calls is the communications center's job, not yours.
Expect to be asked for a description of the problem and your location. Don't worry if you don't know an exact address. You may also be asked for your phone number.
It is also OK to indicate that you are uncertain about something such as whether or not the patient is breathing.
Definitely agree. Especially if you're training is limited (but even if it isn't) making sure someone reaches emergency services should be your top priority. If you need to attend to the injured person, pointing out a specific person and telling them to call 911 is a good approach. It's more likely to get done quickly if a specific person feels it's their responsibility than if it's unclear whose job it is.
One (potentially) big exception to the doing something is better than doing nothing rule, is applying a tourniquet. I have heard in my wilderness safety class that if you apply a tourniquet to a limb, it will probably need to be amputated, and this should only be done if you're confident it's necessary. Applying pressure to a wound that you're bleeding from should always be the first thing you try.
I added the "potentially" above, because I'm having trouble verifying that claim online. The Mayo Clinic says "Having a tourniquet in place for two or fewer hours — the time in which most patients can get to a hospital — should not have any ill effects beyond those caused by the injury requiring the tourniquet. It typically takes at least 4 to 6 hours for tourniquets to cause harm." I think this may be the difference between advice for wilderness training, where you are often >4 hours from a hospital, and first aid training for incidents that may happen in everyday life. Of course, the farther you are from a hospital, the greater the risk of actually bleeding out, and it's better to lose a limb than one's life, so I think you just need to be careful to weigh the risks.
FWIW, most people without training will not apply a improvised tourniquet correctly anyway, so it probably won't make much of a difference either way, but I thought this knowledge was worth sharing.
My understanding is that the anti-tourniquet meme is outdated, and the emergency medical response advice now is that the benefits of potentially preventing someone's death from blood loss outweigh the risk of amputation. I recall being taught in my college course in 2015 that it's fine to put on a tourniquet, just mark it with the time. And a few years ago, when my mom pulled a heavily bleeding man out of the cab of his overturned truck and wouldn't let any of the other truckers apply a tourniquet to his arm because she'd been taught that you should never apply a tourniquet, the nurse who showed up at the scene later (and applied a tourniquet) told her it would have been fine to do so. (Yes my mom is a way better person to go to in an emergency than I am, guess it's not hereditary.)
And I mean yeah, most people aren't going to successfully tourniquet anything even if they try so ¯\_(ツ)_/¯ But I still think it might be anti-helpful to propagate the 'don't apply tourniquets' meme.
Thanks. This is helpful context. The class I took was only a year ago, so I don’t feel like that obviously fits the “this information is just outdated” narrative, but I am genuinely unsure whether it was good advice at this point. On the margin my statement may have been too strong, and I don’t want to suggest that never using a tourniquet is correct, but I do think it’s probably correct for people to know the risks and alternatives before applying one.
Yeah. In the training I took, they said to apply a tourniquet if the bleeding is continuous and more than 6 oz of blood has been lost, in which case the wound is considered life-threatening.
Nice! I've done a few First Aid courses, and I always forget the key ideas, I look forward to reviewing this content and keeping on top of it.
I converted these cards into Thought Saver flashcards; it's much easier for new spaced repetition users to give it a go, and you can embed it directly into forum posts!
Is this particular to LessWrong or is there some browser shenanigans going on in being able to render this?
It's just an embed link that is setup to work with LessWrong and the EA forum.
I have a standard car first-aid kit in my backpack. One like this one on Amazon (no affiliate, just the first that came up). I also put some aspirins in there, an antihistamine for allergic reactions, and a wound clot treatment (many like this on Amazon - not the one I got in Germany).
Could you recommend (or link to a recommendation) of what first aid kit to buy? What should it contain? How expensive should it be? Where should I buy it from?
My problem: I can't tell if someone's heart is beating. I think I even studied CPR specifically when I was young, but I find pulse-checking difficult and unreliable. And what happens if you clumsily CPR someone whose heart is beating?
In the training they tell you to (1) check for responsiveness and then (2) check for breathing. You check for responsiveness by hitting them a bit and shouting “are you OK?” If they are unresponsive but breathing, they don't need CPR. If they are not breathing, or only gasping, they need CPR.
The training did not say anything about checking for a heartbeat.
Unfortunately the legal system doesn't reflect this.
This claim seemed worth checking, especially since there are multiple legal systems and it would be awful to discourage people from saving lives in one jurisdiction based on the flaws of another, so I looked into it briefly.
From my quick investigation, I think that being sued for providing medical assistance is not a serious concern in the USA, Canada, and the UK (and probably not in most other places but I didn't read much about other places). Laws protecting rescuers from lawsuits exist in many jurisdictions; they're called Good Samaritan laws.
I tried to find cases of people being sued for providing medical attention. There was an edge case in California in 2008 when someone caused a paralyzing spine injury to someone when pulling them from their car after an accident, believing that the car might explode. The court ruled that this may have been (intended to be) emergency aid, but it wasn't medical aid, which is what California's Good Samaritan law specified, so the paralyzed person was allowed to sue the attempted rescuer. In response to this incident, California passed a new law stating that "no person who in good faith, and not for compensation, renders emergency medical or nonmedical care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission".
If you're worried about being sued for helping in an emergency, look up Good Samaritan laws in your area. The Wikipedia page on Good Samaritan laws might be a good place to start.
 I'm aware of a famous incident in China in 2011 when no-one provided assistance to a dying toddler, because they were afraid of being sued. China passed a Good Samaritan law in response to that incident, so it's probably fine to attempt rescue in China now.
 I've looked into whether cars explode (separately, a while ago), and concluded that that's not a serious risk after an accident. If a car crashes in precisely the right way (such as falling off a cliff and landing on a protrusion that violently stabs the fuel tank) then it can explode in the initial accident. But an explosion after an accident is exceedingly unlikely, I concluded. A fire after an accident can spread, but I expect that a rescuer can easily evade a car fire if one appears, so I wouldn't be afraid of approaching a damaged car.
In many countries it may even be a reverse!
For example in Poland you have a duty to help another person and NOT doing so will get you sued by the state, exemption being of course if said help cannot be performed without endangering yourself as non-professional rescuer’s safety always comes first in order to not end up with more dead bodies obviously.
Courts will almost always assume that at one point in life - at school, in boy/girl scouts, when doing your driving license, in myriad of other places - you have gone through basic training and so there’s no defence of not knowing the skills.
Moving someone away from a car is included in emergency help and AFAIK there’s no differentiation of medical and non-medical actions.
Even if someone cannot be rescued and is clearly dying there might be a duty of care to comfort them through last moments of their life until emergency services arrive but in practice that’s not so stringent.
You being in shock turns you into a casualty as well and of course may be an exemption, depending on severity, later medical assessment of you etc. etc.
Fun phrase: translating from Polish civil law, if there is an emergency situation you literally “receive a task/quest from a state” to help and I think (very much check me on it) this is what grants you power to break some other laws while performing help (trespassing etc.)
Source: paraphrasing from pap.pl, Polish Press Agency — also: I’m not a lawyer and take my translation with a grain of salt.
Without a source but from my own empirical experience of being a non-pro rescue unit in scout boys (and saving people from crashes and drownings that occurred during our travels, luckily not to us) I can also add that once you call 112 (EU-wide equivalent of 911) then following prompts from the operator falls under this law as well, and depending on severity they may allow you to stand down completely or remind you of your duty if you’re trying to chicken out of helping altogether even if AED is there.
Thank you for pointing this one out @michaelkeenan - it is often a case that in the English-speaking part of the Internet people write about the state (and thus law) as if everyone was living in the US. Going online as a diversity loss function for Europeans, that’s going to be a title of my next post ;-)
I think that is not as clear cut as you suggest*, but also agree that it's not a terrible risk under a number of assumptions.
I think a good thing to take from Jason's post is that one can get some pretty basic training that can prove of immense value to helping others in some not unexpected cases. The benefit I think comes from the core of the legal argument in the link. With some simple training you can start making pretty informed decisions that should help you avoid doing more harm than good due to ignorance or negligence (not considering a risk).
*I will agree that the situation in the news story and legal case is not one of the cases Jason identified but these will always be something of a judgement call and good judgement will depend on knowledge and some training.