Thread by @emedtox

10 years ago today, I experienced a bomb scene. I discovered every first aid & disaster course is incomplete. I am committed to amplifying the most-overlooked, most-important interval that could improve patient care. It is time to optimize improvised care in the #disastergap.

Also called #caregap, the care within is initiated by #spontaneousresponders. Whether trained or untrained, spontaneous responders step up from within a scene itself, doing the best they can, with whatever they have available, to care for others, while experiencing scene hazards.

#SpontaneousResponders are not #firstresponders. They will not be invited to a debriefing. They also are not bystanders and may go home with scene trauma or blood on their clothes. The most overlooked group of rescuers in the most overlooked disaster interval, the #caregap.

Every first aid & disaster course is incomplete. In every first aid and disaster course we teach, we start by teaching, "Is the Scene Safe?", and we advise students not to enter into a scene that is unsafe, but this is so far from reality.

Don't teach your students, "Is the Scene Safe?" The answer to that question is Yes, No, and I don't know. Our current education only teaches ONE answer. We only teach how to proceed if the scene is safe. We literally teach 1/3 of the curriculum in every course we teach.
#EMS

When a disaster scene happens around you & to you, choosing safety is not an option. We default to training at times of stress. If you find yourself in the middle of a dangerous scene, and ask yourself, "Is the Scene Safe?", and the answer is NO, it is NOT SAFE, what's next?

Instead of teaching your students, "Is the Scene Safe??", Look to #FireService education, where they understand scenes are inherently risky and instead teach their students to assess and mitigate risk. It's time to change the way we teach every #firstaid & #disaster course.

It is time to add improvised care to every first aid & disaster course we teach. Until we optimize improvised care within the #CareGap, we are choosing to overlook reality, and more importantly, to overlook opportunities to give victims the best chance at survival.
#EMS #disaster

What is the Disaster Gap?
The #disastergap is a #caregap that exists between the moment of an incident & arrival of freshly dispatched, clear headed #FirstResponders. This gap exists at nearly every scene, and we know nearly nothing about the care provided within this gap.

Who are Spontaneous Responders?
Regardless of prior training, people step up from within the scene itself to help people around them. These are #SpontaneousResponders.
Might be off duty trauma surgeon. Might be shopkeeper or high school student. It could be you.

At the moment, the #disastergap is invisible.
After any major disaster, disaster professionals get together and do a deep dive into what happened, and how the disaster response went. This is called the After Action Report, and it starts with:
Time = 0 (the event itself)

After a major disaster, an #AfterActionReport starts with Time = Zero, the moment of the incident itself.
Next: first calls for help, followed by response time & 1st vehicle on scene.
The entire report is everything after the first vehicle arrives!
But what happened before?
#AAR

It is time to add #disastergap to every after-action report. Until we study improvised, impromptu care by #spontaneousresponders who arise from within the scene itself, within this #caregap, we literally know nothing about this interval. We cannot optimize what we do not study.

What is happening during the #DisasterGap?
Who ARE the #SpontaneousResponders?
Were they trained or untrained?
How did they improvise care?
Was improvised care effective?
How were they affected or traumatized by the scene?
Did they get support to process what they experienced?

I learned a lot after experiencing a bomb scene first hand.
I improvised with what I had as a medical volunteer at a sporting event. I had gloves, stethoscope, permanent marker, and EMS shears.
I had access to some bandaging & IV supplies.
The scene was not safe.
I did my best.

After 2 explosions, I wondered how many more there would be. I thought, "I might die today." Unrelenting fire alarms penetrated my brain. I was breathing smoke & the foul scent of burnt plastic & flesh. I slipped in blood & almost fell on shrapnel & toes. I felt overwhelmed.

I was an emergency doctor with >25 years of EMS/medical training. Others who helped were people without medical training. We all were traumatized yet we did not belong to first responder agencies, therefore not invited to debriefings.
We were not bystanders. We did not stand by.

What I learned is: #SpontaneousResponders in the #DisasterGap
have a shared experience with shared risks, shared needs & shared goals in a shared time interval. These concepts are critically important & relevant at major disasters. It is time to amplify them. Please share.

(And as a final aside, I once read that you should try to make every single tweet in a thread stand alone in case it is retweeted. Now that I'm reading through this thread, it seems choppy because although I met that goal, it doesn't flow easily. Next decade I'll get it right.)🤷🏼‍♀️

Ping: @ThecitizenAID

Here is a video of me speaking 3 years after. I was just putting ideas together & vocabulary has changed a bit.
Previously, I used "immediate responder", but nobody could remember it. People can remember "spontaneous responders". That's why I changed it.
vimeo.com/188766307