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Incident response, a duty of care?

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Incident response, a duty of care?

Martin Gallagher • Feb 03, 2018
How much do you or your organisation invest in Incident Response?
For today’s security professionals the focus seems to be on mitigating Cyber Crime (IT security), Physical security, terrorist attacks, active shooters or the perpetrator at the time of the incident.

IT Security “Spending expected to grow to $93 billion in 2018, according to the latest forecast from Gartner, Inc.”

The global physical security market is expected to reach USD 290.7 billion by 2025, according to a new study by Grand View Research, Inc

Disaster Recovery

So, here’s the thing. What about “Disaster Recovery”? Google those two words and you’ll find almost all pages on disaster recovery relate to IT and Physical Security.

Disaster Management

The United Nations defines a disaster as a serious disruption of the functioning of a community or a society. Disasters involve widespread human, material, economic or environmental impacts, which exceed the ability of the affected community or society to cope using its own resources.

The Red Cross and Red Crescent societies define disaster management as the organisation and management of resources and responsibilities for dealing with all humanitarian aspects of emergencies, in particular preparedness, response and recovery in order to lessen the impact of disasters.

Regardless of the efforts and numbers of the security services, police and military deployed, and the spending on physical security, terror attacks, bombings and shootings are going to continue to happen, and most organisations and people think that it couldn’t happen to them.

Disaster Recovery and Disaster Management should include Incident Response (physical not just desk-top) How much do you or your company invest in Incident Response? Do you train your on-the-ground teams to deal with trauma?

Are you really ready and efficient?

Now ask yourself this question and be totally honest with your answer. “ When a bombing or shooting does happen to me, am I and my organisation as prepared for it as we can be? ” You or your organisation may not be the intended target but remember you may still be affected due to your proximity to the target of attack in your work life or your personal life.

What is critical to remember in your crisis management, disaster recovery and disaster management programs is that immediately after the incident, your human casualties are the most important people at the scene of such an emergency as you have a “Duty of Care” to them. Lives will be lost instantly, further still. even more, lives will be ebbing as the subsequent minutes’ tick away.

The dead and the dying.

Yes, there will be fatalities at the time of the attack or incident, but many more deaths will occur after the event if casualties are not dealt with quickly. Can you really afford to rely on the emergency services in the few minutes after an incident? In reality, the answer is, ” No” .

Paramedics may be prevented from entering the scene by the police or security services for at least 10 to 60 minutes or more after they arrive. It’s here where your employees and your own Emergency Response Team (ERT) if you have one, will make a difference if they have been trained and regularly practiced for such an event. Sadly, normal first aid training and skills will not suffice.

“Uncontrolled haemorrhage remains one of the biggest challenges for medical first responders and the main cause of preventable death.”
In the aftermath of a terrorist attack or serious injury caused by an accident, more casualties will rely on bystanders and First Responders to save their lives. A person with a catastrophic haemorrhage will die in minutes. But if first responders and civilians who are trained in trauma injuries can intervene, the injured will have a much better chance of survival. Catastrophic bleeding is life-threatening. It’s good if it can be stopped; if you can stop it fast, that’s even better. First though, remember “Run, Hide, Tell”. Bystanders and Response Teams must understand that their safety is paramount and only attend other casualties if it is safe to so do.

There are a lot of things that amazing doctors and surgeons can do in our hospitals, but if the casualty doesn’t have their bleeding stabilised on the scene quickly, they are very limited in what they can do by the time the casualty arrives.

Consider an explosion. What type of injuries would you expect to see? I’m sure you would agree that you’d likely find every type of injury possible.

What will a casualty who is in trauma need before the medics arrive? Possibly some or all the following:

  • Bleeding (catastrophic) control
  • Airway Management
  • Resuscitation (CPR/Defibrillator)
  • Oxygen therapy
  • Burn management
  • Immobilisation

    Let’s look at catastrophic bleeding, a casualty has a big gash in their neck, perhaps an amputated limb or both? The casualty has minutes to live. What could you do or use to prevent death? Uncontrolled haemorrhage remains one of the biggest challenges for medical first responders and the main cause of preventable death. What equipment is out there to help you and your response team?

    • Tourniquets
    • Pressure Bandages
    • Haemostatic Agents
    • Tourniquets serve three purposes:They control bleeding chaos
      They buy time for medics in situations where they are dealing with multiple injuries.
      They help control physiological shock because the brain must have oxygen, which is carried by the blood. A brain without oxygen will start to die in 3-4 minutes.
      Direct pressure to a catastrophic bleed alone will not prevent the casualty from dying. Just like in combat, tourniquets can save lives. If you or your team know how to use them properly your performance is far greater than if you don’t know what you’re doing. Good training and practice needs to be undertaken on both purpose (manufactured) and improvised tourniquets 

      Doctors and medics compare the tourniquet to CPR, a simple, life-saving method that anyone can learn. Once you know where a person is bleeding from, apply firm, steady pressure to the bleeding site with both hands; apply pressure using clothing or bandages; if the bleeding continues, apply a tourniquet two to three inches closer to the torso from the bleeding. You may have to use two tourniquets if necessary.

      No matter how quickly the emergency services arrive on the scene, a company’s own Emergency Response Team (ERT), employees or bystanders will be there first. We recommend that everyone is trained in using tourniquets. We also recommend that every organisation should have a trained ERT, which have greater skills than a basic first aid team.

      Remember, you can’t use a tourniquet on a carotid artery bleed (neck) or on an abdominal wound. What would your team be able to do here? Would they cope? Would direct pressure alone work?

      Pressure bandages

      Some of these amazing bandages will apply up to 30 pounds of pressure on a wound, they will also soak up a very large amount of blood. But to stop a catastrophic bleed, a clot is needed to form at the arterial level and it needs to form quickly. A pressure bandage will not do this by itself. It may stem the external flow of blood, but it will not stop it internally. What could you or your team do to prevent further blood loss?

      Haemostatic Agents (HA)

      There are several HA brands out in the marketplace but there is one in particular that we would recommend unequivocally (this is not a sales advert, so I will not mention it by name on here). The brand we use and will stand by has been used by the US military for some years now in Iraq and Afghanistan and they are sticking by it. In November 2017. The UK Ministry of Defence chose this brand as their preferred HA across all its forces.

      Their best product will stop a catastrophic arterial bleed in one minute, (it starts to work straight away) and it works in cold weather where normal clotting of the blood would be impeded by low temperatures, it also works on casualties who are on blood thinning agents like Aspirin, Warfarin, Heparin etc. When the HA comes into contact with the blood, it quickly forms a pseudo clot, that’s exactly what we would need on a major arterial bleed like the carotid in the neck, a femoral (upper leg) or a brachial (upper arm).

      Once pressure has been applied on top of the haemostatic agent in the wound for one minute, it would be perfect to dress the wound with the HA in place by applying a pressure bandage on top.

      “A top league football team trains regular and hard to be at the top of their game. This should apply to your Response Teams”
      As part of your Crisis Management Program, you would need to consider your Crisis Incident Responders (your ERT – Emergency Response Team), the people on the ground who will be there getting their hands dirty or bloody, not just the people around the desk in the Emergency Operations Centre, who would be joined by others from other regions or countries on a conference call.

      Who should be ERT trained?

      Your Emergency Response Team should comprise of your security guards, building facilities teams and other members of staff who have all been trained in first aid already and up-skilled to deal with trauma. An Emergency Response Team needs to be dedicated and well trained. The ERT should not be comprised of personnel who just do first aid training once every three years

      Your ERT would (just like your Crisis Management Team) need to be drilled, assessed and optimised. This means regular practical exercises and scenarios that keep their skills and performance honed. Most companies will send their employees on first aid courses but never send them to annual 3-hour refreshers or have them practice on live-realistic scenarios in the workplace. ( Crisilience Ltd provide free annual refreshers to its clients).

      A top league football team trains regular and hard to be at the top of their game. This should apply to your Response Teams, regular practice, drills and never forget to review and optimise those drills. If this is not done, you’ll find your team at the bottom of the league and unable to cope in a confident, quick and efficient manner to help people dying from what may be a preventable death.

      Critical Incident Management & Awareness Training (CIMAT)

      CIMAT Group provides ERT Training, which enables a company’s responders to cope with horrific injuries. The training is run over an intensive two-day course and culminates with the learners putting their learning into practice on our realistic scenarios. We use real people (some are amputees) who are professionally made up by our artists’ special effects.

      Our teams have backgrounds in the military, have worked in hostile environments or have worked frontline in our National Health Service. We have recently provided our training to the instructors of one of the UK’s largest police force, the feedback was great, so good in fact, the feedback reached managers and directors of other government departments who want us to train their teams.

      This training will benefit corporations, Transport & Infrastructure organisations, Retail companies and Shopping Malls, businesses and locations where people gather, the list is endless.

      For more information on our CIMAT ERT training, or our CIMAT seminars, please visit our website or drop us an email with any questions to info@cimat.org or training@crisilience.com.

    • Enrol on our first aid training courses to learn how to handle emergencies. Call Crisilience Ltd on 07889 151 757

    Based in Northolt, we can provide courses to students across Middlesex and the UK.

    First Aid Refresher

    This relates to our “theory only” Online First Aid Refresher

    Practical elements must be performed face to face with an instructor.

    Although a First Aid at Work Refresher is not compulsory, the HSE and all awarding bodies “strongly” recommend that all qualified first aiders undergo an annual 3-hour refresher.

    Having done your full course, be it FAW level 3 or EFAW level 3 etc, you may never have to use your skills and you may also not review your training until your certificate expires and you have to re-sit or re-qualify 3 years later. Will you remember it all? If you had to use your training as a first aider, would you be competent?

    Why not consider doing our FAW Refresher on-line on our Learner Management System (LMS)?

    Currently, it’s free as it is in BETA stage, (We have the first 5 modules up already). Yes, modules, they are bite-sized with a small quiz at the end of each module. You can do a module at a time and return anytime you wish to continue, the quiz is timed and must be done in one sitting, we have allowed an extremely generous 30 minutes for each quiz, which in reality, could be completed in 5 minutes. When all 20 or so modules are complete there will be a grand quiz, which will test you on all your theoretical knowledge.

    If you feel you didn’t do as well as you expected on any quiz, you can always try it again. In future, the FAW refresher will only be accessed by Crisilience clients and those we have taught for other training organisations. So jump in now and register on our Education site while you have the chance. If you have already registered, visit our LMS site. Of course, we’d appreciate any and all feedback regarding the modules or the program in its entirety.

    Paediatric First Aid 2-day level three course

    This Paediatric First Aid Level 3 two day course is for persons who are working with infants and young children or those who are working towards an NVQ in Childcare and Education (teachers, au pairs/nannies and playgroup leaders).

    This qualification teaches theoretical and practical aspects in First Aid techniques that are particular to infants aged 0 to 1 year, and children aged from 1 year old to the start of puberty.

    Students will become accustomed to the role of the paediatric first aider and be able to assess and respond appropriately to an emergency condition, for example; a child or an infant who is unresponsive, has an airway blockage or is suffering from shock.

    As you will see from the course content below, this is an extremely busy course and is as intense as the Level 3 First Aid at Work course.

    We at Crisilience feel that this course justifies a 3 day attendance, whereas our Awarding Body states, “It was agreed with the First Aid Awarding Organisation Forum, Skills for Care and Development and the Sector Skills Council for the qualification that, in addition to this guidance the minimum contact hours, excluding breaks, should be a minimum period of 12 contact hours, which normally equates to a two-day programme.”

    Although we strongly feel that the course should run over three days, this has not in any way impacted the cost of this course by adding the extra day, which we believe is very beneficial to the learner as the lessons will be delivered at a slower and more relaxed tempo allowing positive information retention and excellent learning outcomes. After all, the welfare and well-being of children is very important.

    Course Content 1
    • Responsibility of a Paediatric First Aider
    • Minimising the risk of infection to self and others
    • First aid and personal protective equipment required for emergencies
    • Using first aid and personal protection equipment safely
    • Information required to be included in an accident report/incident record and how to record it
    • Reporting procedures following an accident/incident
    • Definition of an infant and a child for the purposes of first aid treatment
    • Conducting a scene survey
    • Conducting a primary survey of an infant and a child
    • When to call for help
    • The information required to be given when obtaining assistance
    • Assessing the level of consciousness of an infant and a child
    • The reasons why an infant and a child should be placed in the recovery position
    • Placing an infant and a child in the recovery position
    • Continually monitor an infant and a child whilst they are in the recovery position
    • Assisting an infant and a child who is experiencing a seizure
    • Identifying when to administer Cardio Pulmonary Resuscitation (CPR) to an unresponsive infant and an unresponsive child who is not breathing normally
    • Administering CPR using an infant and a child manikin
    • Identify when a foreign body airway obstruction is mild and severe
    • Administering first aid to an infant and a child who is choking
    • The types and severity of bleeding
    • The effects of severe blood loss in an infant and a child
    • Controlling external bleeding
    • Define the term ‘shock’ relevant to first aid
    • Recognising an infant and a child who is suffering from shock
    • Managing the effects of shock
    Course Content Continued
    • Common triggers for anaphylaxis
    • Recognising anaphylaxis in an infant and a child
    • Administering first aid for an infant and a child with anaphylaxis
    • Types of fractures
    • Recognising suspected fractures, dislocations, sprains and strains
    • Administering first aid for suspected fractures, dislocations, sprains and strains
    • Recognising suspected concussion, skull fracture, cerebral compression and spinal injury
    • Administering first aid for suspected concussion, skull fracture, cerebral compression & spinal injury
    • Conditions affecting the eyes, ears and nose
    • Recognising sickle cell crisis, diabetic emergencies, asthma attack, allergic reaction, meningitis and febrile convulsions
    • Managing sickle cell crisis, diabetic emergencies, asthma attack, allergic reaction, meningitis and febrile convulsions
    • The effects of extreme cold and heat
    • Managing the effects of extreme cold and heat
    • Safely managing an incident involving electricity
    • Treating a casualty of electric shock
    • Recognising the severity of burns and scalds
    • Managing burns and scalds
    • Routes that poisonous substances take to enter the body
    • Sources of information for treating those affected by sudden poisoning
    • Managing sudden poisoning
    • The severity of bites and stings
    • Managing bites and stings
    • Administering first aid for small cuts, grazes, bumps and bruises, small splinters and nose bleeds
    • What and how to record information that is required to record illnesses, injuries and emergencies
    • Confidentiality procedures for recording, storing and sharing information

    Emergency First Aid at Work 1-day level three course

    The 1-day Emergency First Aid at Work (EFAW) Level 3 RQF qualification is for those who are working, or preparing to work, within the industry who would like to become an Emergency First Aider in the workplace for the purposes of the Health and Safety (First Aid) Regulations 1981.

    This qualification launched on 1st October 2017 and replaced the Level 2 Award in Emergency First Aid at Work (QCF).

    On the course, learners will be given their own manual as well as a delegate pack containing all the first aid items necessary for practical aspects of this training.

    Learning Outcomes Unit 1 – The Learner Will:
    • Understand the role and responsibilities of a first aider
    • Be able to assess an incident
    • Be able to manage an unresponsive casualty who is breathing normally
    • Be able to manage an unresponsive casualty who is not breathing normally
    • Know how to recognise and assist a casualty who is choking
    • Be able to manage a casualty with external bleeding
    • Be able to manage a casualty who is in shock
    • Be able to manage a casualty with a minor injury
    Course Summary
    • Introduction to the first aider
    • What is first aid?
    • First aid in the workplace
    • Roles & responsibilities of the first aider – 1 hour
    • Assessing an incident
    • Scene survey
    • Primary survey
    • Casualty communication – 1 hour
    • Principles of resuscitation
    • The respiratory system
    • CPR
    • Adult basic life support
    • Compression only CPR
    • AED (Defibrillator) – 2 hours
    Course Summary Continued
    • Obstructed airway
    • Choking – 1 hour
    • The circulatory system
    • Types of bleeding
    • Wounds & embedded objects
    • Hypovolaemic shock – 1 hour
    • Seizures – 30 mins
    • Minor injuries & burns – 30 mins
    Who is this qualification for?

    This qualification is aimed at learners who wish to become emergency first-aiders in the workplace.

    The qualification meets the requirements for training emergency first-aiders in those organisations that have identified that staff need to be trained to this level within their first-aid needs assessment.

    How long will it take?

    To complete this qualification, learners should expect to undertake 7 hours of learning, typically over one day, with a minimum contact time of 6 hours.

    Topics Covered

    The qualification covers knowledge such as the roles and responsibilities of the first aider and how to assess an incident. The qualification also covers first aid skills in CPR and use of an AED, providing first aid to a casualty who is choking and dealing with external bleeding and hypovolaemic shock.

    Assessment Method

    This qualification is assessed by a practical demonstration and written/oral questioning.

    First Aid at Work 3-day level three course

    RQF First Aid at Work (3 Day Program)

    RQF First Aid at Work (2 Day Re-qualification)

    This First Aid at Work course is available as a three-day program or two-day requalification course, equipping you or your employees with the skills to deal with major and minor emergencies in the workplace.

    This qualification launched on 1st October 2017 and replaced the Level 3 Award in First Aid at Work (QCF).

    Learners will gain the confidence to prioritise casualties and administer the relevant treatment.

    Course Content
    • Health and safety regulations
    • Risk assessment
    • Contents of the first aid box
    • Dealing with emergency situations
    • Casualty communication
    • The initial assessment
    • Assessing for danger
    • Response checks
    • Calling for help (999/112)
    • Management of the airway
    • Checking for breathing
    • Secondary assessment
    • Body checks
    • Recovery position
    • Cardiac conditions
    • Cardio pulmonary resuscitation
    • The chain of survival
    • Safe use of an AED (defib)
    • Choking protocols
    • Resuscitation for children and babies
    Course Content Continued

    Dealing with a casualty who has:

    • Sustained a bleed
    • Been burnt or scalded
    • Shock
    • Broken bones, fractures and dislocations
    • Soft tissue injuries, sprains and strains
    • Eye injuries
    • Head and neck injuries
    • Concussion
    • Compression
    • Skull fracture
    • Spinal fracture
    • Miscellaneous conditions
    • Asthma
    • Anaphylactic shock
    • Diabetes
    • Poisoning
    AssessmentWho is this qualification for?

    This qualification is aimed at learners who wish to become first-aiders in the workplace. This qualification meets the requirements for training first-aiders in those organisations that have identified that staff need to be trained to this level within their first-aid needs assessment.

    How long will it take?

    To complete this qualification, learners should expect to undertake 22 hours of learning, typically over three days, with a minimum contact time of 18 hours.

    Topics Covered

    The qualification covers knowledge such as the roles and responsibilities of the first aider, how to assess an incident and recognising signs and symptoms of injury and illness. The qualification also covers first aid skills in CPR and use of an AED, and assisting a casualty who is suffering from major injury and illness such as chest injuries, spinal injuries and anaphylaxis.

    Assessment Method

    This qualification is assessed by a practical demonstration and written/oral questioning.