Red Cross Red Crescent magazine
RCRC Magazine: First Aid for All
“The last time you showed me this I was too weak to blow up the chest,” says a quiet, middle-aged woman—let’s call her Mary—as she kneels tentatively on the carpet next to a lifeless first-aid mannequin. Mary is living in a rehabilitation centre in Bedford, United Kingdom, fighting to overcome alcohol addiction.
A Red Cross trainer, Dan Sheridan, has come to this two-storey brick house to teach the second of two brief first-aid courses to Mary and three other residents, in the familiarity of their temporary home. Sheridan structures the course as a conversation rather than a lesson, asking questions, making jokes and encouraging them at every step. “There you go, relax, it’s not so hard,” he coaches.
Mary bends over, pinches the mannequin’s nose and breathes into its mouth. When the chest rises, she smiles in relief. These days she spends most of her time learning to heal herself. Today, she has acquired the skills to save somebody else.
“That’s great,” says Sheridan. “See, you can do it.”
A civic duty
First-aid has been at the core of the Red Cross Red Crescent Movement ever since Henry Dunant organized civilians to help injured soldiers after the battle of Solferino in 1859. It’s more than a skill — it’s an act of humanity. Given without discrimination, it helps empower communities to take greater care of their own survival and well-being. It’s a responsibility of global citizenship and an essential element for safe and resilient communities.
“First-aid training is a key activity for us,” says Nehal Hefny of the Egyptian Red Crescent Society, noting that there is a real desire for training at the community level because, very often, city or state emergency services cannot respond quickly enough in many parts of the country. “The training is one of our main activities and it’s very popular.”
Whether it’s inner-city Cairo, a remote village in Myanmar, the favelas of Brazil or a London suburb, first-aid training offers people the chance to take life-saving action and demonstrate humanitarian values in their own community. In places where there is little or no access to emergency services, there is a real hunger for basic life-saving skills. “People are often really looking for the skills to be able to prevent and respond to emergencies by themselves,” says Eric Bernes, a first-aid specialist for the ICRC.
“Everyone has the potential to save lives,” adds Grace Lo, a first-aid specialist for the IFRC.
Reaching out to vulnerable communities, she says, is key to attaining the goal of ‘First Aid for All’, the theme of 2010’s World First Aid Day, planned by the Red Cross Red Crescent for 11 September. To mark the occasion, the IFRC has published an advocacy report following up National Society first-aid training efforts around the world.
Still, in many parts of the world — in both high- and low-income countries — first-aid training needs to be brought to many more people and communities. In many high-income countries in Europe, for example, the public often views first aid as an optional skill. Those who have taken a course in the past might think they have paid their dues, even if they cannot remember a thing today (studies show that ideally, a person should have a refresher course every 6 to 12 months).
Diane Issard, manager of the European Reference Centre for First Aid Education, says that to ensure help is within reach at all times, at least 30 per cent of the population should know first aid. And yet, a recent IFRC advocacy report shows that even in Europe, there are great disparities. In Norway, for example, 95 per cent of the population knows basic first-aid techniques, while in Hungary, less than 1 per cent of the public is trained.
Part of the reason is legislation. When a government requires citizens to learn first aid at school, makes it a condition for obtaining a driving licence or requires it at the workplace, the numbers automatically go up. Unfortunately, many governments often don’t see first aid as a political priority. School curricula are already overloaded. Driving licences are costly enough. This point of view overlooks the fact that first aid can save not only lives but money, by reducing the cost of medical treatment.
One country that is moving toward requiring first-aid training is Ghana, where traffic accidents are a leading cause of fatalities: more than 1,600 annually. With the support of national authorities, the Ghana Red Cross Society is working to expand a programme in eastern Ghana that has already offered first aid training to more than 3,000 licence applicants. The victory is not without challenges — the most immediate one being a lack of mannequins, a costly investment for developing countries. “Now that we have the mandate,” says Kofi Addo, the Ghana Red Cross Society’s acting secretary general, “we must demonstrate the capacity to deliver.”
In China, some provinces oblige people to undergo Red Cross training before obtaining their driving licences. On the other hand, there is little public encouragement for learning first-aid skills and no mandatory requirement for high-risk industries. With support from national lottery funds, the Red Cross Society of China has been working in recent years to improve quality, standardize courses throughout the country and communicate the importance of first aid to the public at large.
Back to basics
But first-aid training is not just about learning technical skills. It’s about giving the public the confidence to act. Even when people are trained in first aid, they sometimes hesitate. Some are afraid of blood or of catching diseases. Many are concerned about lawsuits, despite the fact that legal judgements in such cases are extremely rare. Nonetheless, worries about making a mistake often lead to the so-called bystander effect, whereby everybody counts on somebody else to act. That is unfortunate — even a clumsily performed cardiac massage can save a life, whereas no action at all is certain to end in death.
As a result, a number of National Societies are coming to the same conclusion, that teaching complicated first-aid manoeuvres puts people off. In the Netherlands, fewer than 2 per cent of the population has learned first aid, because for years the public was offered only one type of course, which lasted 32 hours and was expensive.
In 2005, the Netherlands Red Cross finally received the right to teach first aid and decided to rethink the entire process. “Some National Societies focus on issuing first-aid certificates,” says first-aid specialist Patrick Logister. “But even in countries where 80 or 90 per cent of the public is certified, if nobody helps, or is taught effective techniques, the effect is non-existent.” The Dutch have chopped down the course length, put more focus on target groups such as young parents and are trying to encourage a propensity to act by educating the public that lawsuits should not deter anyone from trying to provide life-saving first aid.
In Argentina, the Red Cross is also striving to improve and simplify instruction methods, after realizing that most of what they teach is forgotten after one year. “First aid was always taught like school, with manuals like textbooks,” says Martin Roth, an anaesthesiologist and long-time Red Cross volunteer. “The teacher gives a lesson and you practise. That may be good for kids, but adults have another way of learning.”
The National Society worked with an adult education expert, who suggested a case-study approach, with abbreviated content, small discussion groups and lots of practice. “We’re focusing on the most elemental, vital things, so they can be remembered,” says Roth.
Dan Sheridan agrees. “These people don’t want to be lectured or preached at,” he says. “The trainer as a font of knowledge — that just creates a barrier. Make it safe and familiar, tell them, ‘You already have the answers, guys, just bring it out’.”
The goal is to make first aid accessible to all, including the most vulnerable members of society. The Italian Red Cross and the Hellenic Red Cross in Greece are training blind people to prevent and deal with domestic accidents, the Finnish Red Cross trains elderly people and youth at risk, the Armenian Red Cross Society has a programme for remote communities, the French Red Cross has worked with young people in inner cities, the Netherlands Red Cross is developing a programme for Muslim communities, the Russian Red Cross Society trains factory workers and some Chinese Red Cross branches train migrant workers. For its part, the British Red Cross has been giving more attention to empowering people with physical and mental disabilities.
In Afghanistan, the ICRC provides first-aid training to all parties in the conflict, as well as supporting the Afghan Red Crescent Society in the delivery of first aid services and training to civil society members such as taxi drivers, who often take the injured to hospital. “Taxi drivers tell us that first-aid skills are really important for them,” says Bijan Frederic Farnoudi, the ICRC’s communications officer in Kabul. “They can’t evacuate a person to the hospital in the normal time frame of two hours, but need to take complicated, indirect routes, so the journey may take up to seven hours. Those extra hours are often the difference between life and death.”
In conflict zones, or in areas with chronic violence, such as the favelas of Rio de Janeiro or Cité du Soleil in Port-au-Prince, Haiti, first aid is also a means to make a connection, to open a dialogue with key players and combatants and create a certain “humanitarian space”, says ICRC’s Bernes.
“It’s much more than a bandage,” he says, adding that those who provide first aid in dangerous situations are also setting the highest example of humanitarian values in action. “Yes, the first-aid givers are saving lives. But just as importantly, they are restoring a sense of confidence and hope — especially when you have a situation of violence, whether it’s war, gangs, banditry or whatever. Acting in these situations creates a level of hope that people are not only destructive but can also act to help each other.
“It really is the DNA of the Movement,” he says of first aid. “Since Solferino, it’s remained an extraordinary vehicle. A hallmark of the Movement that nowadays needs to be really reinforced.”
Opening the door
First aid can also become an entry point towards developing people’s trust and clearing a path to more sensitive issues. In Ireland, a community-based health and first-aid programme was introduced in 2009 in Dublin’s Wheatfield prison, a medium- to high-security facility and home to 450 male prisoners, many of whom are long-term inmates. The project, a partnership between the Irish Red Cross, the prison’s healthcare division and the city of Dublin’s vocational education committee, started as a way to avoid bringing the H1N1 epidemic into the penitentiary.
Twelve prisoners were chosen to participate as Red Cross volunteers and receive first-aid education with relevant health awareness. They took classes two hours a week, then passed on what they had learned to the rest of the prisoners. It seemed to work: a neighbouring prison had several cases of swine flu, but there was not a single one at Wheatfield.
But Graham Betts-Symonds, the prison’s healthcare and nursing manager, was most struck by the transformation in the volunteers who participated. “While some [prisoners] had behavioural difficulties in the past, they appear to have completely changed as Red Cross volunteers,” he says. Perhaps the most amazing result was the response to a mass HIV testing project in June 2010, after first-aid courses highlighted HIV awareness as a key health issue. In the days leading up to the tests, the volunteers passed out leaflets, encouraged other prisoners to go and talked openly about the virus. The turnout exceeded all expectations.
A survey was held during the tests and the prisoners’ responses proved that, without peer support, many would not have bothered showing up.
“If medical people came around, prisoners would go back into cells,” wrote one. “RC guys 1,000 per cent better doing this than staff doing it,” noted another.
“Makes you more on the ball about HIV/AIDS , especially about unprotected sex,” said a third.
And one prisoner wrote: “Thank God it’s being done.