Imagine an ordinary day at work. The coffee is fresh, and you wait for your next assignment. Then it happens.
The disaster alarm goes off and it is yours and your teams’ responsibility to respond. It could be a natural disaster or a terrorist attack.
Hundreds, maybe thousands of people, are affected. Hundreds may need health care; many may already have lost their lives. Civilians are already at the scene facing the calamity.
In these circumstances, one can easily be overwhelmed by the magnitude of the situation, but at the same time the EMS personnel are trained to respond to emergencies, no matter how small or big they are.
It is in our backbone to always provide medical care and offer help.
The above imaginary scenario is no longer unthinkable, and the reality is that you, as a first responder, one day could be the one on duty when the alarm goes off on a massive disaster or a critical security incident.
This article will introduce you to the NO-FEAR project1 (Network Of practitioners For Emergency medicAl systems and cRitical care) and describes some of the challenges associated with bystanders and non-organized volunteers, whilst outlining how you can engage with the project activities.
The NO-FEAR Project
EMS plays a vital role in assisting wounded and sick people after security incidents.
However, there are several challenges that need to be addressed. As a response to these challenges, the pan-European NO-FEAR project was launched in 2018.
This coordination and support action project brings EMS, suppliers, academia, decision makers and policy makers together to collaborate and exchange knowledge, good practices and identify lessons learned.
Many of the NO-FEAR partners are practitioners who were directly involved in the terrorist incidents in Paris, Nice, Berlin, Madrid and Barcelona.
Based on their experiences, the consortium initiated the project to better prepare and respond to several challenges that EMS face, and to overcome difficulties, such as:
• A fragmented chain of actors responding to security related incidents.
• A need for actors to respond to new threats such as terrorism and armed convicts.
• A lack of communication between the practitioners working in the eld and suppliers providing goods and services.
• No common methodologies and standardised actions.
The threat and risk situations today are quite different from just a few years ago, and security and preparedness plans are constantly being adapted to respond to new challenges.
Cross-border collaboration to develop a common understanding of the innovation potential gives this project a unique opportunity to improve the capabilities of EMS to respond to new threats, and assist casualties after security incidents.
This in turn will fill operational gaps and identify areas for future research, making EMS more resilient.
A higher frequency of natural disasters, critical security incidents and terrorist attacks are a growing trend in Europe and beyond.
The correlative rescue work is unpredictable, challenging and involves well known dilemmas and potentially dangerous situations.
When disaster strikes, we must be prepared, but what about the people already on site – the bystanders?
Civilians: The First to Save Lives
Bystanders and non-organized volunteers usually initiate life-saving measures quickly. It is a misconception that people become helpless or panic during a crisis.
Although one may be affected by fear, the desire to help is stronger. The official report after the shootings at Utøya in Norway, 22nd of July 20112 points out what a valuable resource the ordinary man and woman are when disaster strikes.
At Utøya, in addition to logistics on water, civilians also performed first aid, provided warm blankets and clothing, and showed tremendous care and compassion.
In the minutes following a critical incident, there will normally only be the wounded and bystanders on site before the police and EMS arrive.
These minutes can be critical for severely injured people and can mean the difference between life and death. Bystanders who understand the urgency of the situation may feel an immense responsibility.
Getting an overview of the situation and simultaneously trying to save lives with minimal resources contributes to additional stress3.
Reports tell the story of former bystanders who say that leaving someone behind is not an option, even with a “great personal risk and subsequent injury”4.
When the shootings at Utøya started, it did not take long before people at the landside understood that something was wrong. They heard gunshots and saw youths jump into the water, swimming for their lives.
We have also learned from the reports that young survivors from Utøya tried to help friends escape the gunshots.
Residents on the landside and camping guests collaborated to rescue the hypothermic and injured teenagers.
Whilst the youths immediately started to help each other, the residents and the camping guests got their boats on the water and went out to rescue the cold and injured teenagers. Some of the volunteers were shot at while saving lives2.
Nevertheless, they kept transporting injured persons to the mainland. These volunteer efforts continued for some time after the police and EMS had arrived.
At some point, volunteers even provided water transportation for the police. Later they said: “the collaboration with the professionals was good, but it took them a long time to arrive”5.
The concern is not about people’s willingness to contribute when disaster strikes, but whether there should be limitations to what actions one can expect from bystanders.
Although it is sometimes necessary for first responders to make use of bystanders and non-organized volunteers to effectively meet the needs of the injured, the ethical reflections around whether professional responders put non-professionals in harm’s way, either physically or emotionally, must be taken into consideration and further discussed.
Given the unpredictable nature of any crisis, we understand that being near or on the site of the incident involves personal risks, but EMS has a duty to act, balanced by a duty to consider relative risk6.
At the end of the day, we are the ones who need to prepare for, and gain knowledge of, how to leverage bystanders and non-organized civilians as medical force multipliers during MCIs (mass casualty incidents)4.
The Perception of the Bystanders’ Efforts?
Even those who work with adverse events may perceive a crisis as surprising and threatening. At the same time, they are expected to make decisions very quickly and with overwhelming pressure7.
Hence, it is not difficult to understand if and why professional first responders associate bystanders with increased chaos and stress, rather than as essential resources in the rescue work.
However, research8 has previously shown that the inherent altruism of the population is crucial to the efforts made to save lives under acute incidents.
This selfless concern for the wellbeing of others may explain why people help each other, carry out life-saving measures and stand together in times of crisis. Empirical evidence suggests that the civilian population can provide valuable resources which have not been fully utilized.
One reason may be the argument that when many want to “do well”, chaos and ambiguity can arise, which in turn can be problematic for the professionals8.
One cannot stop people from arriving to offer help, but too many people with the desire to contribute can also be a burden and an obstacle to the professionals doing their job.
This can lead to negative attitudes and wrong assumptions towards the bystanders. Nevertheless, we know that it takes time for professionals to respond to critical incidents and, in the immediate aftermath, the affected must rely on themselves.
Bystanders and non-organized volunteers can and should be considered a resource in crises, from which EMS can benefit.
By coordinating efforts and eventually taking over full responsibility, the information and work already carried out can be utilized for:
• A better understanding of the situation.
• Efficient and correct crisis management.
• A better outcome for both lives saved and psychosocial aspects following the disaster.
This form of crisis management is based on collaboration to achieve control of the situation7. However, it is important to keep in mind that each crisis is unique.
The affected will have varying degrees of knowledge and needs, thus presenting different reactions to a situation.
Raising awareness of the inevitable interaction between the EMS and bystanders is crucial in achieving a better understanding of the value each group has when joining efforts to save lives.
National guidelines for establishing easily available first-aid courses to the public could be a way of strengthening the societal resilience.
But first and foremost, it is important that training in managing the bystanders and non-organized are embedded in a standardized education for EMS.
There will always be civilians who are first at the scene of injury and in many cases initiate life-saving measures, sometimes also further safeguarding the disaster area.
As a resource, bystanders are currently not fully exploited, meaning a considerable potential for strengthening society for emergency purposes remains to be utilised.
To contact Anna and find out more about the NO-FEAR project, you can email her at: email@example.com
2 Departementenes servicesenter Informasjonsforvaltning. (2012). Rapport fra 22. juli- kommisjonen (NOU 2012:14). Oslo: Departementenes servicesenter.
3 Kruke, B. I. (2012). Samfunnssikkerhet og krisehåndtering: Relevans for 22. juli 2011. Notat: 7/12. Risikostyring og samfunnssikkerhet, Krisehåndtering,
4 Universitetet i Stavanger. https://www.jems.com/2016/08/01/leveraging-bystanders-as-medical-force-multipliers-during-mcis/
5 Haug, C.S. & Folvik, A. E. (2011, 24. juli). Han reddet 20-30 ungdommer fra terroristene på Utøya. Dagbladet. http://www.dagbladet.no/2011/07/24/nyheter/innenriks/terror/utoya/anders_behring_breivik/17436710/
7 Rosenthal, U., Boin, R. A. & Comfort, L. K. (2001) “The changing world of crisis and crisis management”. I: Rosenthal, U., Boin, R. A. & Comfort, L. K. (Eds.) Managing crises: threaths, dilemmas, opportunities. Spring eld III., Charles C. Thomas.
8 Helsloot, I. & Ruitenberg, A. (2004). Citizen Response to Disasters: a Survey of Literature and Some Practical Implications. Journal of contingencies and crisis management, 12 (3), s. 98-111. http://www.researchgate.net/publication/227847952_Citizen_Response_to_Disasters_a_Survey_of_Literature_and_Some_ Practical_Implications?enrichId=rgreq-8ae3e470-bb43-42ed-82ba-79145833939d&enrichSource=Y292ZXJQYWdlOzIyNzg0Nzk1MjtBUzoxMzE1MjIzOTY5NTQ2MjRAMTQwODM2ODc5MTI1NQ%3D%3D&el=1_x_2