Can a first aider leave someone to die?

We recently got some fan mail (yes, people do love us) that I think is worth discussing here in more detail. It seems to me that the person had read our ‘4 Bs’ article. Cutting right to the chase, the core question is “Can a first aider leave someone to die?” To which the only logical answer is, “Sometimes,” but you better have a darn good reason. Now, here’s part of the eMail. The other thing worth knowing is that it comes from Nigeria.

I sat under a Medical Doctor for a training on Basic First aid. During the training, he said one of the  first priorities of a first aider is to save a conscious person first before the unconscious person and for the three Bs, given an accident scenario, the first thing to do is to stop bleeding first before checking for breathing in the victim or casualty. I tried to argue this out but he said this is based on the Triage Training. In my own view, I think an unconscious person should be attended to since the conscious person is breathing; saving a life  is a more urgent task than reducing pain and suffering.

First Aider, or MD?

Triage labelsSo, first, we have to point out that we teach first aid. It’s very different from triage training. I have no idea if the MD was trained as a first aid instructor, but it seems unlikely. We shouldn’t confuse our work as first aiders with triage done by an MD. Triage means ‘To Sort’ and while we do that in first aid, it’s not the same as full triage training done by health care professionals.

Pain and Suffering

Next keep in mind that first aid training and the 4 B’s are about saving lives. Sorry, but your comfort is secondary to me – I’m here to save your life. Actually, I think the MD referenced in the email would feel the same way, it’s the person asking the question who has put his own interpretation on the MD’s teaching. So let’s get that out of the way – if you’re acting to save lives, immediate comfort is secondary (but also important in extended care situations).

What are you doing?

Physiologically speaking (studying the way bodies ‘work’) there’s really no point plugging all the holes, and keeping the blood in, if it has no oxygen to carry. The oxygen is essential for life. Undertakers will not give points for pretty bandaging! Still, there’s no point doing CPR if every compression empties half a pint of blood all over the floor. That can’t last long (about 16 compressions before you empty an average adult). In really rough situations, you might need to strike the right balance.

What have you got?

So, can a first aider leave someone to die? Depends on what you got. Let’s imagine two situations:

  • 1. Your dumb cousin just shot himself.
  • 2. A crazed American teenager just shot up the school (and for some reason you’re there first, on your own)

One is pretty straight forward – use your first aid training to deal with whatever happened, try not to laugh at your relatives, get EMS/ambulance on the way. Not necessarily in that order.

Two is more challenging – who knows what casualties you might meet. So assuming you’re safe to be there….. Let’s give you one person in need of CPR, ten with severe bleeding, and others. You know from your basic training (or because you’ve read our blog) that breathing comes first – so you should do the CPR. You also know (you read this post too) that the survival rate even if you do good CPR isn’t that high without an AED. At the same time, you have enough training and kit that you can stop all ten from bleeding out. You can save ten lives for sure and risk one; or possibly save one while risking ten. So can a first aider leave someone to die? You bet – but it’s a pretty weird situation to be in.

Where are you?

whistler mountains“Can a first aider leave someone to die?” Also depends on where you are. It’s something we actually have to keep in mind here in Sea 2 Sky country – you can quickly find yourself in places ambulances don’t come and helicopters find difficult to reach. If you’re doing CPR in the back country, 4 hours from the last road, 6 hours from any occupied buildings and who knows when you last saw phone reception then we might ask – what are you doing? Practicing? (But there may be plenty of good reasons to keep going.)

But usually, we’re in towns & cities and expecting help to arrive soon. Hospitals and doctors, nurses & others are near by and we generally can expect a degree of success. So we follow the 4 Bs, 3 Cs, 3 Ps and all the other training we’ve had.

Rule of Thumb?

Single casualty and you in ‘civilization’ – breathing/CPR comes first. A long way from help and essentially on your own/small group – do your best but realize it might not work (take a Wilderness course). On your own with so many casualties it scares you – then we have to say ‘yes’ to the initial question of ‘can a first aider leave someone to die’? But you still best have a darn good reason!

 

About Tony Howarth

Tony is a First Aid & CPR Instructor Trainer with Sea 2 Sky Safety Training Services and the company founder. Tony started with the British Red Cross in 1994. Has acted as first aid attendant for hundreds of events & treated many hundreds of people as a result. He is experienced in training a wide range of courses. He previously worked as an ambulance attendant with the British Red Cross. He is now in BC as a first aid instructor, and an instructor trainer (one who trains others to become instructors) Finally, Tony works at UBC Hospital as a pharmacist when not busy training safety
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3 Responses to Can a first aider leave someone to die?

  1. Paul says:

    This is a question which is almost impossible to answer because there are so many possible scenarios. If you are alone and are performing CPR at some point you need to stop if only from the stand point of fatigue. if you are hurt yourself and it is either you or the person you are trying to save then it depends on your relationship with that person (if it were my wife or one of my two kids I would die trying to save). If the person is bleeding and you can stop the bleeding and can go get help (but that is not leaving the person to die). The only reason I could see leaving someone is you are trying to save them and there is no way to get them mobile and if you don’t leave them you could die yourself such as the middle of a storm, forest fire, etc. Otherwise if the person is going to die and you are not leaving to get help the only ‘human’ thing to do would be to stay with them and comfort them until they passed.

    An example was an overturned truck in the middle of the night when I was driv1ng down the highway 25 years ago. I saw the truck and pulled over. My wife flagged down a car that had a cell phone and the called 911. The truck was spilling gas but more importantly was the moaning driver wedged in the drivers seat. I held his hand while blood poured from his body and waited for the fire department. I did not worry about a fire because I really did not think it would happen and I talked to the guy. I told him everything would be okay as he cried in pain. All the while I knew he was going to die. I did not leave him because he had a ‘right’ to human contact and to not die alone. As it turns out he lived. I did not identify myself because I was there to help not get any form of thank you. I have no idea what his name was or if he is alive today but I do know this…..whether he lived or died that night he was not alone. He had the comfort of knowing there was a voice at the other end of his cries which meant there was hope for him (in his mind) and he was not left to die like a dog.

    To answer your question: the only reason you can (in my humble opinion) leave someone to die is if you are going to die. Or if there is someone else also hurt who you are able to transport out to save but timing is of extreme importance. It is what makes us human…empathy!!!!

    • Tony Howarth says:

      Thanks for the comments. It was a difficult one to write – as you say, so many variables. Even as it is, we should probably have written a section about who you have to help you do first aid. Don’t think we can ever get one correct answer tho.

  2. Pingback: First Aid: Severe Bleeding Scenario | HEALTHCARE

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