Injured protesters lie on the ground as Turkish riot police officers fire tear gas to disperse demonstrators gathered on the central Istoklal avenue near Taksim square in Istanbul, on May 31, 2014, as the police blocked access to the square during the one year anniversary of the Gezi park and Taksim square demonstrations. (AFP Photo/Bulent Kilic)

At big demonstrations your buddy & you may find yourself in a situation where there are more hurt & injured protesters than there are street medics. You will need a system to categorize the casualties according to the severity of their injuries, the resources you have available and will need to assign treatment appropriately!

Triage Roles:

• Assign the street medic buddy team with the most street medic/medical experience to Co-ordinate the designated treatment area/safe space (Triage Zone). This team will perform continuous assessment. They will sort multiple casualties into priorities and dispatch other buddy teams to casualties who need immediate care. They do not provide hands-on treatment if available resources allow it. Their primary role is to assess and assign a treatment priority to injured people as they arrive in the Triage Zone.

• Street Medics within the Triage Zone will  be designated casualties according to treatment priority. They will provide treatment and/or stabilize and monitor for further deterioration. They stay with their assigned casualty until such a time as they hand over care.

• Other Street Medic & helpful protester buddy teams will direct injured persons who can walk to the Triage Zone. Walking casualties are generally considered a lower priority.

• If safe, subsequent buddy crews can explore the surrounding area and identify other injured persons. People who are unconscious, confused or otherwise unable to seek medical attention on their own. If able the buddy crews can help or transport these casualties back to the Triage Zone. If not they need to communicate with the Triage Co-ordinator buddy team as to the next course of action.

Triage Priorities:

• Casualties should be placed into one of three triage priorities according to the severity of injury and urgency of treatment.

 

• Level ONE/RED: Immediate threat to life, including: patient not breathing or no pulse, uncontrollable and rapid bleeding, anaphylactic shock. Patients in this category require immediate evacuation to hospital – call 000 or 112.

 

• Level TWO/YELLOW: Life or limb in serious jeopardy, including: broken bones, altered state of consciousness, severe bleeds and potential future need to restore breathing and/or circulation. Most patients in this category will require assistance from paramedical services, if not hospital care – call 000 or 112.

 

• Level THREE/GREEN: Neither life or limb in jeopardy. Pepper spray & tear gas decontamination with no Red Flags are treated in this category. Treatment is required but a longer delay is acceptable and hospitalization may not be required.

Key Triage Principles:

• Situational awareness: (what is happening with the demo, the cops and the environment – like which way is the wind is blowing and effects of exposure).

• Know the number and location of injured and the severity of their injuries.

• Prioritize treatment/help for most injured casualties and who are in most danger of deteriorating further.

• Locate protesters with minor wounds and monitor them in the Triage Zone

• Identify vehicle access so EMS can pick up the Level ONE & TWO injured

• Identify available resources: helpful protesters, self-aid, medical equipment (your kit & fellow street medics), water

• Remember: pushy & verbal casualties who demand treatment aren’t necessarily the most in need of it and may distract from the silently deteriorating casualty.

It’s important to keep dry when protesting because the body loses heat 20 times faster when wet. Shivering is an early sign of mild hypothermia but you should also keep an eye out for the “umbles”, that is: stumbling, grumbling & fumbling.

Treating Hypothermia:

1. Stop the exposure. Move the protester to a warm, dry and sheltered space (this also prevents the Street Medic from getting  hypothermia as well). Unconscious casualties lose a huge amount of body heat into the ground so if their airway and spine are clear, roll them onto a mat or blanket.

2. Remove wet clothing – but leave any dry clothing on. Don’t forget to ask consent before removing a casualty’s clothing.

3. Wrap the casualty with blankets or a thermal blanket. Heat packs can be placed on the groin, neck, and armpits.

4. Casualties who are able to follow commands and sit upright should slowly drink warm, non-alcoholic beverages.

RED FLAGS:

Symptoms may worsen as the casualty warms. Cold blood in the extremities flowing back to the heart may lower body temperature further.

As hypothermia progresses shivering will stop in order for the body to conserve energy therefore a casualty who has stopped shivering may be deteriorating.

Call Emergency Medical Services immediately if the casualty shows signs of confusion, a diminished level of consciousness or slurred speech.

Stop a bleeding nose: Bloody noses can start spontaneously or through digital trauma (nose picking!) or as a result of a impact with something blunt. Most nose bleeds will self-resolve BUT in a protest situation a serious nose bleed needs to be treated immediately.

1. Remove the casualty to safe space.

2. Sit them down and get them to lean forward.

3. Apply rubber gloves from your First Aid kit.

4. Using your thumb & index finger, squeeze soft part of the nostrils closed.

5. Continue holding till bleeding stops. If the bleeding is heavy or there is swelling, place an ice pack from your First Aid kit on the bridge of nose.

6. If you are called off to treat another casualty you can insert a tampon into the affected nostril or give the casualty a bunch of gauze from your First Aid kit.

Aftercare:

Advise the casualty to avoid picking, blowing or rubbing nose for two days. Dispose of all blood soiled equipment appropriately.