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React Faster, And Better, With The A B Cs

Rich May 2, 2008 2 Comments

I’ve had a bit of a weird week. As I mentioned on Monday, I was driving to physical therapy (physio for my Australian and European friends) when there was an accident in front of me and I stopped to help out. Wednesday night I was coming home from PT and there was another accident right as I was going through the intersection. This one was far more serious. As soon as I heard the smash and saw the impact out of the corner of my eye, I pulled into the median, hit my hazard lights, and called 9-1-1. One of the advantages of working in the field for so long is that you learn an economy of words to describe a complex situation in just a sentence or two of the crucial information. My first call was: I’m on-scene of an injury accident at the corner of [x and y]. Two vehicles, with an unconscious unresponsive patient with a compromised airway. Patient is entrapped in the passenger side of the vehicle with access through the driver’s side door. I’m a former paramedic and need to go manage her airway There was a bit more jargon, but not much. The patient was unrestrained in the car with the airbag deployed, which probably meant she hit her head on the passenger window or strut since it was a side impact. There were a bunch of other bystanders and one came out and identified himself as a flight nurse. Her head was slumped over, which caused her difficulty breathing. The nurse jumped in the back of the car, we tilted her head to a normal position and stabilized her neck (one of the few times you’re allowed to move the neck after an accident). Her breathing got better, and she slowly started waking up, but clearly had a head injury, which we reported to 9-1-1. The fire department showed up a few minutes later, we got out of the way, and she was being loaded into the chopper as I drove off. That might be one of the only times I’ve stopped to help at an accident where my assistance may have mattered. Truth is, unless you’re on the ambulance or have advanced equipment with you, the most useful thing you can do is calm the patient and make sure there isn’t any more damage. The kinds of injuries you sustain in a major accident are rarely something even a highly trained bystander can help with. I didn’t even bother evaluating anything more than her breathing, since nothing else mattered. All you EMTs can skip that full survey if you’re helping as a bystander in an urban area. In this case her head position was keeping her from breathing well, making the situation worse. Just moving it so she could breathe more normally might have oxygenated her noggin a bit more and helped her wake up. Why the heck am I talking about this on a security geek blog? Because it’s one of those times where there are direct lessons we can apply to our world, and often forget. I’m a big fan of Rothman’s philosophy of REACT FASTER. The idea is that it’s more about how you respond to an incident than having the incident in the first place. Truth is in IT, as in life, bad stuff will happen no matter what you do. Systems will crash, hard drives will die, and hackers will break in. David Mortman is one of the other major proponents of this philosophy- incident response is just as important, if not more important, than incident prevention. That’s why I’m adding REACT BETTER. Emergency services are just like programming- a series of algorithms in a structured program flow. It all comes down to the A B Cs- Airway, Breathing, Circulation- in meat-space. Patient have any airway? Nope? Then nothing else matters until you fix that. Breathing? Check. Circulation okay? Then move on to spinal immobilization. It’s a recognition that you can’t jump from A to C and expect success. It’s exactly what we did to help that girl in the car, rather than focusing on the blood or other distractions. Don’t just react- have a response plan with specific steps you don’t jump over until they’re complete. Take the most critical thing first, fix it, move to the next, and so on until you’re done. Evaluate, prioritize, contain, fix, and clean. (You OODA fans should love this). And always remember the loudest patient is rarely the most important. If they’re screaming their head off, their airway is fine. It’s the quiet ones you have to watch out for. Share:

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