Safety, assessment and alert

1The first aider's role: protect, alert, assist

First aid is the help given by a person on the spot, with little or no equipment, until medical help arrives. It has three aims: preserve life, prevent deterioration and promote recovery.

The approach fits in three words: protect (yourself, the casualty and bystanders), alert (emergency services or the nearest health facility, according to your organisation's medical plan) and assist (the right actions, within the limits of your training).

In humanitarian settings, medical help may be hours away. A first aider must therefore be able to monitor a casualty for a long time and know the organisation's medical evacuation plan (MEDEVAC): who to call, which vehicle, which health facility, how far away.

2Securing the scene and protecting yourself

Before touching a casualty, look around: traffic, fire, electric wires, unstable buildings, a hostile crowd, the risk of a second explosion after a first one. An injured first aider is one more casualty. If the danger cannot be removed, and only if it is possible without risk, move the casualty; otherwise, wait for the right resources.

• Wear gloves whenever there is blood or body fluids; if none are available, use a clean plastic bag.
• Wash your hands before and after, or use alcohol-based hand rub.
• If the casualty's blood comes into contact with a wound or mucous membrane, or after a needle-stick: wash, then seek medical advice immediately for possible post-exposure prophylaxis (to be started as soon as possible, within 72 hours at the latest).

3Assessment: response, airway, breathing

The assessment follows a fixed order, dealing first with what kills fastest.

1. Response: speak loudly, tap the shoulders. "Can you hear me? Open your eyes."
2. Catastrophic bleeding: visible heavy bleeding is treated immediately, before anything else.
3. Airway: in an unresponsive casualty, gently tilt the head back and lift the chin.
4. Breathing: look, listen and feel for no more than 10 seconds. Gasps (infrequent, noisy breaths) are not normal breathing.

If the casualty is not breathing normally: have someone call for help and fetch a defibrillator, and start resuscitation (day 2). If they are breathing: recovery position, then a full head-to-toe check (wounds, pain, deformities) and monitoring.

4Calling for help: a clear and complete message

Who to call depends on the context: the national emergency number if it exists and works, otherwise the organisation's medical or security focal point, the referral health facility or the local Red Cross or Red Crescent. These numbers must be in every vehicle and in the security plan.

The message always follows the same order:

• Where: exact location, landmarks, GPS coordinates if possible.
• What: type of accident or illness, number of casualties.
• Condition: response, breathing, bleeding, actions already taken.
• Who: your name and a call-back number. Only hang up when the other person tells you to.

5The professional framework: standards, duty of care and the first aider's limits

This online course provides knowledge, method and clinical reasoning. It is in no way a substitute for certified hands-on first aid training, with scenario practice and manikin training, delivered by a Red Cross or Red Crescent National Society or by an accredited provider in your country. Skills are learned with the hands, under the eye of an instructor, and are maintained through regular refresher training.

First aid is not a scaled-down version of emergency medicine: it is a discipline in its own right, with its own evidence-based recommendations. The international reference for the Red Cross and Red Crescent Movement is the International First Aid, Resuscitation and Education Guidelines published by the International Federation (IFRC) in 2020. They build on the systematic reviews of ILCOR (International Liaison Committee on Resuscitation), which publishes its scientific consensus statements every year. In Europe, the European Resuscitation Council (ERC) translates this consensus into guidelines, the latest full edition of which dates from 2021 and includes a dedicated first aid chapter. National guidelines (for example those of a ministry of health or a National Society) may adapt these texts to the local context: where they differ, the first aider follows the protocol in which he or she was trained and certified.

What the IFRC means by first aid

The 2020 guidelines define first aid as the immediate help provided to a sick or injured person until professional help arrives, and they explicitly include the psychological dimension and self-help. They stress three principles that underpin this entire course:

• Evidence first: a skill is taught only if it is useful and safe. Practices that were once widespread (distant pressure points, routine elevation of a bleeding limb, cervical collars applied by first aiders, suction of a snakebite) no longer appear in the guidelines, either for lack of proven benefit or because of the risk they carry.
• Adaptation to context: the guidelines recognise that professional help may be far away, that equipment may be lacking and that scene hazards may be high. They distinguish what is recommended everywhere from what depends on the resources available.
• Education as an intervention: competence declines quickly after training if it is not maintained. Short, frequent refreshers are more effective than long courses spaced several years apart.

The organisation's duty of care

For a humanitarian organisation, first aid capacity is part of its duty of care towards its staff and, in many cases, towards the people it assists at its sites. The Core Humanitarian Standard (CHS), in Commitment 8, requires that staff are supported and that their safety and well-being are taken into account. The Global Interagency Security Forum (GISF) guides on security risk management build the medical plan and medical evacuation into the security plan. In practice, an auditor or security manager will check:

• that there is an up-to-date medical plan for each base, known to the teams;
• that the number of trained first aiders is sufficient for every movement and every site to have at least one trained person present (labour law in some countries sets a ratio; otherwise, the organisation defines one according to risk);
• that certificates are valid and refresher training is scheduled at the interval set by the certifying body;
• that kits are complete, checked and restocked after use;
• that every medical incident is reported and followed by a lessons-learned review.

The first aider's limits

The first aider acts within the limits of his or her training. He or she does not diagnose, does not prescribe, and does not administer medication except where the protocol explicitly allows it (for example helping a person use their own adrenaline auto-injector, or take sugar in case of hypoglycaemia). The first aider obtains the consent of a conscious casualty: a person with capacity may refuse help, and that refusal is respected, explained, and recorded with a witness if possible. For an unresponsive casualty, consent is implied. For a minor, the parent or responsible adult is sought, without delaying a life-saving action.

The legal framework for bystander intervention varies from one country to another: some countries impose a duty to rescue, others explicitly protect the first aider acting in good faith (Good Samaritan provisions). The organisation must know the rule in the country of operation and include it in its briefing. In all cases, an action consistent with the training received and carried out in good faith is the best protection.

Rule of conduct: do what you have been taught, do not do what you have not mastered, and never delay calling for help in order to perform a secondary action.

Neutrality and non-discrimination

In conflict settings, a humanitarian organisation's first aider provides care on the basis of medical urgency alone, without distinction of affiliation, ethnicity, religion or side. This principle, derived from international humanitarian law and the Fundamental Principles of the Movement, is also a security condition: a team perceived as partial becomes a target. It applies to triage (day 4) just as much as to a simple assessment.

6The full assessment step by step: primary survey, secondary survey and monitoring

The assessment presented in the previous sections (response, catastrophic bleeding, airway, breathing) makes up the primary survey: it looks for what kills within minutes. When the casualty shows no immediate life-threatening condition, or once that condition has been managed, the first aider carries out a secondary survey, followed by continuous monitoring. In settings where evacuation takes several hours, it is often the quality of this monitoring and of its handover that makes the difference.

Step 1: the approach and general impression (first few seconds)

While approaching, after checking for safety, the first aider observes: is the casualty moving or talking, what colour is he or she, is there blood on the ground, what is the body position, and what is the likely mechanism of injury (fall from height, vehicle impact, explosion, collapse without trauma)? The mechanism guides what follows: a violent impact calls for limiting movement of the head and neck; a collapse in an older person points to a cardiac cause or a stroke.

Step 2: the structured primary survey

Recent guidance, such as the WHO and ICRC Basic Emergency Care approach, places catastrophic bleeding at the top of the sequence, before the airway. The following sequence, adapted to the first aider's level, can be used:

To describe the level of consciousness simply and in a form that can be handed over, many services use the AVPU scale: the casualty is Alert (awake, eyes open), responds to Voice, responds only to Pain, or is Unresponsive. Any deterioration from one level to another is essential information that must be passed on immediately.

Step 3: the secondary survey

The secondary survey has two components, which can be carried out in parallel if two first aiders are present.

History-taking, from the casualty or witnesses. A widely used memory aid is the acronym SAMPLE:

• Signs and symptoms: what do you feel, where does it hurt, since when?
• Allergies known.
• Medications taken regularly (heart, epilepsy or diabetes treatment, anticoagulants).
• Past medical history: known conditions, pregnancy, recent surgery.
• Last meal: last food and drink (useful if surgery is likely).
• Events: what exactly happened, and in what order?

The head-to-toe examination, wearing gloves and explaining each action: head and face (wounds, bleeding from the nose or ears), neck (pain, deformity), chest (symmetrical movement, wounds), abdomen (pain, rigidity), pelvis (without compressing or moving it), limbs (deformity, wounds, movement, sensation and colour of the extremities), and the back if the casualty can be examined without being moved unnecessarily.

Step 4: vital signs a first aider can observe

Without medical equipment, the first aider can measure and record:

• Respiratory rate: count chest movements for 30 seconds and multiply by two, or for a full minute in a child. In an adult at rest, a normal rate is around 12 to 20 per minute. For children, the WHO and UNICEF Integrated Management of Childhood Illness (IMCI) strategy defines fast breathing as: 60 per minute or more under 2 months, 50 or more from 2 to 12 months, 40 or more from 1 to 5 years.
• Pulse, at the wrist (radial) or neck (carotid): fast or slow, regular or not, strong or weak. In an unresponsive casualty, a pulse check is not used by a first aider to decide whether to start CPR: it is the absence of normal breathing that counts.
• Skin: colour (pale, grey, bluish), temperature, sweating.
• Level of consciousness (AVPU) and orientation (name, place, day).
• Pain, on a simple 0 to 10 scale if the casualty can answer.

Step 5: monitoring and record-keeping

A seriously ill or injured casualty is reassessed continuously; a stable casualty at least every 5 to 15 minutes depending on severity and the local protocol. Each reassessment is recorded with the time. The first aider also records every action taken (time a tourniquet was applied, start of CPR, number of shocks delivered by the defibrillator). This sheet travels with the casualty and is handed to the medical team taking over care.

If it is not written down, it was not done. A simple, time-stamped monitoring sheet handed to the medical team is worth more than a long verbal account given amid the noise of an emergency department.

7Alerting, MEDEVAC and CASEVAC: building the field chain of care

In a country with a functioning emergency service, raising the alarm means dialling a number. In most humanitarian settings, the chain of care has to be built in advance by the organisation. Without a prepared plan, the time lost finding a vehicle, a facility able to operate, or movement clearance often exceeds the time the casualty can survive.

Terminology

• CASEVAC (casualty evacuation): transport of an injured or sick person by non-medical means (organisation vehicle, pick-up, boat), usually to the nearest health facility.
• MEDEVAC (medical evacuation): evacuation with medical escort (equipped ambulance, air ambulance), often organised by an assistance company or by the medical service of the organisation or of the United Nations.
• Referral facility: a health facility whose level of care is known in advance (health post, health centre, district hospital with an operating theatre, referral hospital with intensive care and a blood bank).

Building a base medical plan: an eight-step method

1. Map the facilities within a relevant radius: name, level, surgical capacity, availability of blood transfusion, a defibrillator, antivenom and rabies vaccine; opening hours; direct contact of a manager. Visit the facilities rather than relying on an old list.
2. Measure actual travel times by day and by night, in the dry season and the rainy season, taking account of checkpoints and curfew hours.
3. Define the means of transport: available vehicles, whether a casualty can lie flat in the back, boats, agreement with a humanitarian air operator (for example the United Nations Humanitarian Air Service where it operates) and its conditions for accepting a sick passenger.
4. Identify the decision-makers: who triggers an evacuation (head of base, security focal point, medical adviser), who approves expenditure, who contacts the assistance company and with what information (insurance policy number, passport, blood group if known).
5. Set up communications: verified phone numbers and radio channels, satellite phone, call signs, procedure if the network goes down.
6. Prepare the documents: an emergency information form for each staff member (contacts, allergies, medication, blood group if the person agrees to share it), kept confidential and accessible only to the designated manager.
7. Pre-position the equipment: basic kits and a trauma kit, a post-exposure prophylaxis (PEP) kit in line with the organisation's policy, survival blankets, a folding stretcher, a water reserve.
8. Test the plan: an exercise at least once a year and at each major team rotation, with real timing between the call and arrival at the facility.

The enhanced alert message

The basic message (where, what, condition, who) remains the rule. For an evacuation request by radio to the base or the medical focal point, the information the decision-makers need is added. The template below is inspired by the evacuation request formats used by organisations and United Nations missions, simplified for civilian use.

Deciding between waiting and evacuating by your own means

The general principle is simple: when a competent emergency service can arrive within a reasonable time, you wait and monitor. When that is not the case, the organisation decides to transport the casualty by its own means. The criteria weighing on the decision are the severity and trend of the casualty's condition, the real distance to a facility able to treat the problem (a bleeding casualty needs an operating theatre, not a health post), the security of the route and the time of day, and whether the casualty can be transported lying down and monitored. The decision is taken by the person designated in the plan, after remote medical advice if possible, and recorded with the time.

The fastest transport is not always to the nearest facility: a health post without a surgeon wastes time for a casualty who needs an operation. That is why the level of each facility must be known before the incident.

8Worked example: road traffic accident on an isolated track

Fictitious context: the NGO "Horizons Partagés" runs a water, sanitation and hygiene programme in Morelle district. A team of three (an engineer, a community mobiliser and a driver) is returning from a village 2 h 30 min from Kalo base. The mobiliser and the driver have held first aid certification for eight months; the engineer did a refresher two years ago. The vehicle carries a basic kit, a commercial tourniquet, two survival blankets, an HF radio and a satellite phone. The base medical plan designates Mira district hospital (operating theatre, no intensive care) at 1 h 20 min and Tobé health centre (nurse, no surgery) at 25 minutes.

Timeline

The completed monitoring sheet (motorcyclist)

Post-incident review

• What worked: the scene was secured before any contact; roles were assigned immediately; the radio message was complete; the destination decision was based on the level of the facility rather than the distance; time-stamped monitoring made it possible to report the deterioration at 12:05.
• What needs to improve: the engineer's refresher training was out of date and she did not feel confident; the kit contained no splint or sling material; the Mira hospital number in the medical plan was no longer valid and the base lost five minutes finding it.
• Actions agreed: refresher training for all field staff before the end of the quarter; malleable splints and triangular bandages added to all vehicle kits; monthly check of the medical plan numbers by the security focal point; incident report sent to headquarters within 24 hours in line with procedure.

The decisive point in this example is not a technical skill: it is the combination of a secured scene, a structured alert and a destination decision based on prior knowledge of the facilities. That is exactly what the medical plan must make possible.

9Reusable tools: checklists and field sheets

The following tools are designed to be printed, laminated and kept in vehicles, offices and kits. They must be adapted to the protocol of the body that certified your first aiders and validated by your organisation's medical adviser.

Checklist 1: scene safety (before any contact)

• Traffic: vehicle parked safely, hazard lights on, warning signs placed upstream and downstream.
• Fire, fuel, gas: ignition off, no smoking, fire extinguisher within reach.
• Electricity: cables on the ground, damaged installations; do not touch the casualty until the power is cut.
• Structure: cracked building, unstable wall, risk of collapse.
• Environment: flood water, slopes, animals, extreme heat.
• Human threat: hostile crowd, armed presence, risk of a secondary explosion, unexploded ordnance.
• Biological and chemical hazards: blood, body fluids, unusual smell, several casualties with no apparent injury (think of mass poisoning).
• Personal protection: gloves, eye protection if splashes are possible, pocket mask for rescue breaths.

Checklist 2: minimum content of the base medical plan

Sheet 3: assessment and handover (one page)

Sheet 4: verbal handover to the medical team

An effective verbal handover takes less than a minute and follows a fixed order, inspired by the structured formats used in hospitals:

1. Who the casualty is (age, sex) and what happened (mechanism, time).
2. What was found (injuries and life-threatening problems).
3. What was done (actions, times).
4. How the condition has changed (improvement, stable, deterioration).
5. What concerns the first aider and any outstanding questions (for example: unknown medication, possible allergy).

Checklist 5: after the intervention

• Disposal of soiled waste and gloves in an appropriate container.
• Hand washing; in case of blood exposure, immediate application of the exposure procedure.
• Incident report in line with the organisation's procedure, within the set deadlines.
• Restocking of the kit used, on the same day.
• Debriefing with those involved and offer of support if needed (day 3 and day 4).

10Common mistakes, contextual variations and what auditors look for

The most common mistakes in the field

Contextual variations

Sudden-onset crisis (earthquake, flood, cyclone): health facilities are themselves affected, roads are cut off and communications are saturated. Pre-established medical plans must be re-verified in the first hours; teams need greater self-sufficiency in equipment. Scene hazards (aftershocks, weakened buildings, contaminated water) predominate.

Protracted crisis: the main risk is routine. Kits run down, phone numbers change, trained staff leave and are not replaced. A schedule of checks and exercises is essential.

Camp or displacement site: high population density, many bystanders, crowds gather quickly. Health partners present on site (clinics, mobile teams) must be included in the plan, with their opening hours. Community volunteers trained in first aid are a major asset.

Urban settings: public emergency services often exist but may be overwhelmed or unable to access certain neighbourhoods. Traffic can make transport slower than in rural areas. Electrical, fire and collapse hazards are more frequent.

Remote management: when international staff cannot travel to the field, responsibility for first aid rests with national staff and partners. The organisation must fund their training and equipment to the same standard, and guarantee them the same access to evacuation and insurance. Unequal treatment between categories of staff in terms of security and care is a breach of duty of care that auditors will flag.

High insecurity: night movements may be prohibited, roads closed, checkpoints slow. The plan must provide for prolonged care on site (several hours), alternative routes, and safe-passage agreements for medical evacuations. The ICRC and National Societies are often the only actors able to negotiate such passage.

Local partners with limited capacity: first aid training is a concrete and valued element of capacity strengthening. It must be budgeted in proposals (certified training, kits, refreshers) rather than left for the partner to cover.

What auditors, donors and insurers look for

• Existence and updating of the medical plan and the security plan, and evidence that they have been shared with teams.
• Training register with certification and refresher dates, broken down by staff category and by partner.
• Medical incident reports and lessons-learned reviews, and evidence that the agreed actions have been implemented.
• Signed and dated kit checks.
• Consistency between the budget (training and equipment lines) and reality on the ground.
• Equal treatment of national staff, international staff and partners.

11Interview questions and key references

The following questions are frequently asked in interviews for security focal point, head of base, field coordinator, logistician or health manager positions. The answer guidance indicates what a panel expects from an experienced candidate.

1. "You are first on the scene of a road traffic accident with two casualties. Describe your first few minutes."

A strong answer starts with scene safety (vehicle parked, hazard lights, fuel, traffic), then assigning roles, early alerting by a third party, the primary survey beginning with catastrophic bleeding, the decision on positioning based on response and breathing, and time-stamped monitoring. It mentions limiting head and neck movement in case of violent trauma, and a structured handover.

2. "How do you build a medical plan for a new base?"

The candidate mentions mapping and visiting facilities to establish their actual level of care, travel times by time of day and season, decision-makers, communications, confidential individual forms, equipment, coordination with the assistance company, and testing through a timed exercise. He or she refers to regular updating and to the inclusion of partners.

3. "How do you decide between waiting for an ambulance and transporting a casualty yourself?"

The candidate sets out the criteria: severity and trend, the real response time of emergency services, the distance to a facility able to treat the problem, route security, whether the casualty can be transported lying down and monitored, and remote medical advice. He or she specifies that the decision lies with the person designated in the plan and that it is recorded.

4. "A member of your team refuses to be evacuated after collapsing. What do you do?"

The candidate assesses the person's capacity to decide (consciousness, orientation), explains the risks, seeks medical advice, respects an informed refusal, documents it with a witness, arranges monitoring and reassessment, and informs line management in line with procedure. He or she distinguishes this case from that of a confused person whose decision-making capacity is impaired.

5. "How do you ensure duty of care towards national staff and partners under remote management?"

The candidate talks about equal access to training, equipment, insurance and evacuation, dedicated budget lines, tracking of certifications, and the need to consult the staff concerned about the risks they consider most important.

6. "Which international guidelines govern first aid, and what do you do if they differ from the national protocol?"

The candidate cites the 2020 IFRC guidelines, the ILCOR consensus statements and the ERC guidelines, and explains that the first aider applies the protocol in which he or she is certified, while the organisation ensures that its training remains consistent with current guidelines.

Key references

• International First Aid, Resuscitation and Education Guidelines (2020): International Federation of Red Cross and Red Crescent Societies (IFRC), with its Global First Aid Reference Centre.
• International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: International Liaison Committee on Resuscitation (ILCOR), published annually.
• European Resuscitation Council Guidelines (2021), in particular the chapters on basic life support and first aid: European Resuscitation Council.
• Basic Emergency Care: approach to the acutely ill and injured: World Health Organization and International Committee of the Red Cross.
• First Aid in Armed Conflicts and Other Situations of Violence: International Committee of the Red Cross.
• The Sphere Handbook (2018), Health chapter: Sphere Association.
• Core Humanitarian Standard on Quality and Accountability (CHS), Commitment 8: CHS Alliance, Groupe URD and Sphere.
• Security Risk Management: a basic guide for smaller NGOs and related guides: Global Interagency Security Forum (GISF).
• Integrated Management of Childhood Illness (IMCI) strategy: WHO and UNICEF.

Reminder: this online course does not replace certified hands-on first aid training. Enrol in a course with the Red Cross, the Red Crescent or an accredited provider, and keep your skills up to date through regular refresher training.