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.