Citizens with Trauma Training Improve Emergency Response

A former fire chief explains how with a half-day of training, citizens can improve survival rates before emergency response arrives.


It takes as few as three minutes to bleed to death from a traumatic injury, and it takes time for emergency response to be notified and first responders to make their way to the scene. But when someone is dying, time is a matter of life and death.

While 5-7 minutes is certainly an acceptable response time for emergency responders in many communities, in other communities, like Barrow, Alaska, where my colleagues and I recently taught a First CARE Provider class, the response time could be hours or days depending on such variables as weather and distance. The North Slope Fire District is responsible for over 90,000 square miles.

Barrow represents an extreme example of prolonged emergency response times, but in fact, even in a metro or suburban area, response times can vary greatly depending on the scope of a disaster, the number of concurrent emergency calls resulting from that disaster and the number of responders available at any given time. The International City Managers Association set the acceptable rate of emergency responders at about 1 responder for every 1,000 residents. That translates to very few responders when a major incident occurs, like a tornado or a hurricane.

Teaching Citizens to Respond to Trauma

Survivable injuries include bleeding to death (exsanguination). Uncontrolled post-traumatic bleeding is the leading cause of potentially preventable death among trauma patients, according to the World Health Organization.

If proper interventions are performed within the first 3-5 minutes for injures such as critical bleeding, there is a 90-percent chance that the injured person will survive. With that in mind, we get a much bigger bang for the buck or return on investment teaching civilians to use tourniquets than we do teaching CPR.

Reducing Incident Deaths & Increasing Resilience

To build truly resilient communities we first have to dispel the myth that emergency response personnel will solve all of our problems. We must acknowledge that for the first 5-7 minutes in an emergency, the true first responders are the people who are present at the time of the incident.

Teaching those First Care Providers to deal with traumatic injuries will save lives and empower those who receive the training to make a difference rather than just calling 911 and hoping help arrives in time. One thing I have learned over the past 30 years is that hope is not a plan.

I am not advocating that people sitting at home see or hear a story about a bus accident and leap from their chairs to go render aid. I am talking about teaching the people who may be on that bus sitting next to their child, spouse or friend to act and to save that loved one’s life by compressing a bleeding wound, applying a tourniquet or relieving an airway obstruction. Emergency responders have to get past the idea that we are the only ones who can help in these situations.

Civilians with a modest amount of training can make a difference when it comes to treating traumatic injuries, such as by:

  • Addressing critical bleeding with tourniquets and wound packing
  • Preventing airway obstruction with the Heimlich maneuver
  • Treating breathing problems resulting from trauma, such as chest seals

Half-Day Citizen Training Sessions Could Save More Lives

Through a series of exercises held during First Care provider training sessions, we have found that average people with as little as a half day of training are almost as effective as trained responders in recognizing critical issues like bleeding and intervening.


Trained = Civilians who have completed First Care. | Training Untrained = Civilians before any training. | EMS = Trained EMTs, Paramedics and RNs.

To be a truly resilient community, we much teach people how to rely on themselves in the critical first 5-7 minutes it takes for even the most robust response systems to reach the victims of traumatic injury.

First responders have to start looking at their residents as force multipliers instead of hapless bystanders that need to be moved out of the way during an emergency. Emergency response has to dispel the illusion that we will always be there in time to make a difference. We have to acknowledge and prepare citizens for the reality that with a modest amount of training, those on site during an emergency can provide meaningful and effective first care before the professionals arrive.

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Rob Wylie

Chief Rob Wylie is a 29-year fire service veteran who retired as fire chief of the Cottleville FPD in St. Charles County, Mo. Rob has served as a tactical medic and TEMS team leader with the St. Charles Regional SWAT team for the past 19 years. He is a certified instructor and teaches at the state, local and national level on leadership, counter terrorism and TEMS operations. He graduated from Lindenwood University, the University of Maryland Staff and Command School and the National Fire Academy’s EFO Program. Chief Wylie is also a member of the Fire Chief/FireRescue1 Editorial Advisory Board.

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