First aid in the modern Movement
Following the floods in Mozambique in 2000, first aiders cared
for the injured and prevented the spread of infectious diseases
inside refugee camps.
First aid remains at the heart of Red
Cross and Red Crescent activities. Today the movement is expanding
and upgrading first-aid training and services to better respond
to the humanitarian challenges of the 21st century.
The Red Cross and Red Crescent must be one of the few organizations
whose emblems have come to symbolize generically the core
activity with which it is most closely associated: first aid.
The general public might be a little hazy about exactly what
the emblems mean when placed on a flag, or a door, or a building
- whether they indicate an organization or just the status
of something. But paint a red cross or crescent on a white
metal box and anyone asked will say, "That's a first-aid
"First aid is the foundation for what the Red Cross
does in terms of the culture and principles of the Movement,"
says Alvaro Bermejo, a medical doctor and the director of
the Federation's health department. "It's also the foundation
in terms of service delivery. But we have to move beyond the
'blood and bandages' image in order to make it strategic."
Few National Societies have had the importance of first-aid
skills brought home to them more dramatically than the Nigerian
Red Cross Society, from whose Lagos branch volunteers dashed
on the night of Sunday 27 January when they heard of the catastrophic
explosions at the city's Ikeja military arms dump. Their confidence
as first aiders had been strengthened by a British Red Cross
project to help upgrade both standards and training methods.
But they were severely hampered by exploding ammunition preventing
them getting too close to the casualties, according to Lyn
Covey, recruitment and training manager for the Surrey branch
of the British Red Cross and the chief first-aid adviser to
the Nigerians. She says the horrific accident at Ikeja was
"a first-aid encyclopaedia in a single incident".
Ironically, most of the victims were killed, not by the explosions
and fires, but by drowning when they stampeded into a nearby
canal in a desperate effort to escape the lethal inferno.
More than 1,000 people died. But the Nigerian Red Cross still
emerged as the heroes of the hour. "The only agency on
the ground was the Red Cross," Sola Ajayi, a Lagos resident,
told the BBC.
The British project in Nigeria addresses the challenge of
making the National Society more bankable as trainers, able
to offer structured courses to private corporations for a
fee, with first aid now established as an important form of
marketable expertise for National Societies. And the Ikeja
disaster, as effectively as any in recent years, also encapsulated
both the classic importance of first aid in saving life after
accidents and its vital role in preparing volunteers for humanitarian
work in general.
For Stephen Claffey, project manager of the Federation's
first-aid global project, the "strategic importance of
first aid to the Movement as a whole" is difficult to
overstate. "The World Health Organization provides leadership
on health issues, United Nations High Commissioner for Refugees
on refugee concerns," he says unequivocally. "Red
Cross and Red Crescent National Societies worldwide are primarily
identified with first aid and perceived as providing leadership
in first aid."
The project helps them implement the 1999 General Assembly
policy enshrining the strategic importance of first aid for
National Societies and communities. Now a key priority for
the Federation, it seeks to facilitate knowledge and practice
exchanges between National Societies and with their partners,
and is intended to rationalize first-aid activities within
the Movement. It will develop a set of standards for kits,
training and delivery that will ensure the continuing quality
of service based on communities needs and capacities.
Alvaro Bermejo stresses the revenue generation possibilities
of first aid, and in particular many National Societies' virtually
unassailable position as market leaders in first-aid training.
"I remember when I was in Bolivia," he says, "seven
out of nine branches were making a living from first-aid training."
Since the 1999 General Assembly this approach has also been
the official policy of the Federation, which notes that first-aid
training is "beneficial for resource mobilization and
First-aid training in many countries worldwide - Germany for
example - is fiercely competitive, almost a model of a free
market in which the consumer is king. In Australia there are
more than 250 providers, but in late 2000 the country's national
marketing institute gave the Australian Red Cross an award
for excellence in recognition of its success in converting
its first-aid training service into a profitable commercial
exercise. "With the help of corporate sponsors, we implemented
a campaign focusing on branding, best practice and standardization
of our services and products," said Jim Carlton, then
secretary general of the society.
First-aid specialists flag the danger of instructors leaving
the Movement once they realize how much their skills are worth
in the private sector. There may also be a risk, some feel,
of branch work being neglected in favour of for-profit tuition
projects run from national headquarters. But the consensus
is that, broadly speaking, National Societies are striking
the right balance, using lucrative first-aid activities to
support services to vulnerable communities.
And few have done more to advance the cause of first aid
within their own borders and beyond them than the Danish Red
Cross, which has trained over a million people in first-aid
techniques and lobbied for first-aid training to be made compulsory
in school and driving test curriculums. The Danes - determined
that there should be at least one qualified first aider in
every workplace in the country - last year reissued their
highly successful interactive CD-rom for the training of first
aiders. "The CD goes out free to companies and we follow
up with a phone call to get managers to arrange Red Cross
first-aid courses for employees," says Sven Hedegaard,
the National Society's first-aid manager. "It reflects
our commitment both to this core Movement activity and to
our faith in up-to-date training methods using computers."
Claffey also sees the Regional First-Aid Day as "an
important demonstration of the value of first aid, providing
a focus for National Societies to promote first aid to the
public". The next will be on 7 September 2002. "We
are continuously challenged by the changing risks of our living
environments," he says. "Effectiveness in life-saving
has demanded we move beyond actions of immediate care to engage
in prevention and preparedness activities in diverse situations,
critical elements of the universal assistance required to
protect and save life today."
Singapore Red Cross organized a first-aid competition among
"Classical, textbook Movement"
First aid has come a long way from its origins in military
medicine and the capsarii in the Roman army of the first century
BC - specialist battlefield bandage carriers who wore the
uniform of the soldiers they treated. Chris Paul Giannou,
the chief surgeon in the ICRC's health and relief division,
is a man for whom the phrase "been there, seen it, done
it" might have been coined.
The 52-year-old Greek-Canadian has never actually been an
"ordinary" doctor, moving straight from medical
school to what turned out to be a ten-year stint as a volunteer
with the Palestine Red Crescent Society. His first mission
as an ICRC delegate was in 1990 and he has served in Somalia,
Cambodia, Afghanistan, Burundi, Chechnya and, in Nairobi,
as surgeon for the whole sub-Saharan Africa region. He was
also the medical coordinator of the ICRC's campaign to ban
Dr Giannou speaks passionately with a slight rasp in his
voice. He emphasizes his arguments carefully, one of them
being that there is little real distinction to be made between
civilian and military first-aid skills, although the ICRC
has developed slight modifications in advanced aid techniques
for war wounded. "Battlefield medics do first aid,"
he says. "And we have long been using National Society
people to train military stretcher bearers - in the last couple
of years in the Democratic Republic of the Congo (DRC) and
Uganda, for example." By the end of its current programme
for DRC this year, the Congo Red Cross, with ICRC support,
will have trained some 2,500 army medics, not just in the
treatment and evacuation of casualties from battlefields but
also, crucially, in "their rights and duties" as
wearers of Red Cross armbands. "It's classical, textbook
Movement," Giannou says.
Confidence to act
First aid, of course, is as old as the Red Cross itself;
it is deeply rooted in its past, and in various forms represents
its future, too. It has to be adapted to the much wider world
of health and care in the community, evolve with changing
environments and lifestyles, and absorb relatively new issues
like psychological care, HIV/AIDS and renascent diseases,
some of which can be conquered by volunteer-based immunization
and prevention campaigns. Furthermore it implies healing not
only "the wound" but also the wounded.
Rose Kinuka, the head of social mobilization for the Uganda
Red Cross, is well placed to understand this evolution. Red
Cross volunteers - thousands of them - were crucial to the
success of a measles immunization drive in Uganda late last
year. Not all the volunteers were trained first aiders, but
the ones who were turned out to be "double-good",
as she puts it. In a labour-intensive operation like mass
immunization, something is needed beyond simple exuberance
and a wil-lingness to don a Red Cross T-shirt, the Ugandans
found, and the discipline of first-aid training used in an
innovative way fitted this bill perfectly.
A Magen David Adom team operating in Jesuralem on 27 January
just after a suicide bomb attack.
First aid is most associated with bandages and blankets.
But increasingly, it is developing into a more holistic notion
of care, providing both physical and psychological support.
After the earthquakes that shook El Salvador last year, Red
Cross psychological support teams found themselves trying
to help people who said they had been traumatized by feelings
of helplessness as much as the original disaster; lacking
the confidence to act. "Older children especially were
grappling with guilt," recalls Paul Keen, a San Salvador-based
project manager for the Federation.
"In Nicaragua, which is still recovering from Hurricane
Mitch," Keen explains, "the Red Cross is working
at a school in the muncipality of Posoltega to address this
issue. The children remember their terror as a landslide from
a nearby volcano buried their village. As part of a first-aid
course for teachers and children the school now carries out
an earthquake simulation, with the older children providing
treatment and organizing evacuation."
The Baphalali Swaziland Red Cross is a society which, by
common consent, has throughout its history been seen as the
leading provider of first-aid training in the small southern
African kingdom, and is now marketing that expertise productively.
"The latest figures show that 12 per cent of our income
nationally comes from commercial first-aid training,"
says Secretary General Khanya Mabuza.
"But out in the branches it can be even higher - 70
per cent in Manzini, for example." First aid has also
been one of the society's best recruiting sergeants, with
youngsters at school often becoming Red Cross-trained first
aiders before actually starting work as volunteers. Like other
National Societies in southern Africa - a region with some
of the highest HIV rates in the world - the Swazi Red Cross
has been careful to "integrate" HIV awareness with
first aid. "People were naturally wary of things like
mouth-to-mouth resuscitation, so we have been careful to provide
advice about exactly how HIV is transmitted - and how it isn't,"
says Mabuza. "If there are no surgical gloves available
at an incident, look around for a sheet of plastic, but at
the end of the day you cannot leave someone to bleed to death
in the street."
The hardest test
The current violence in Israel and the Palestinian Territories
is an almost unimaginable cauldron for first aiders on both
sides, the most severe test of their skills and their mental
fortitude and one that makes the issues facing paramedics
on a conventional battlefield seem straightforward.
In early April, two medics of the Palestine Red Crescent
Society (PRCS) were killed and several staff were wounded
while 28 were detained in early April. "Recent events
have had a serious impact on the mental well-being of our
crews," says one PRCS representative in Ramallah. "There
is also the 'reverse stress' of being subjected to long waits
at checkpoints, verbal and physical abuse by soldiers, and
being prevented from collecting casualties. On numerous occasions
sick or injured people have died in ambulances." The
PRCS is now providing psychological support for its ambulance
crews - a service the society hopes to expand to include more
intensive treatment for crews and their families.
Dr Wael Qadan, the head of the PRCS Emergency Medical Service,
says as many as 90 per cent of "101" emergency calls
from West Bank villages go unanswered because PRCS vehicles
cannot get through. "Most villages are blocked with earthworks
and the psychological pressure on staff makes them very tense,
leading to a decrease in the efficiency of the system,"
he says. "They are all operating at great risk."
With the attack on the Jenin refugee camp last April, challenges
for first aiders have reached a critical stage. Endless days
of non-access to casualties by humanitarian rescuers were
succeeded by an intensive search for survivors in the devastated
town. Racing against time, PRCS rescuers have spared no effort
to mobilize all available teams - some of its staff had been
detained in the course of the Israeli offensive - in order
to treat numerous wounded and sick. They had also to spot
and evacuate corpses buried in the rubble in order to prevent
the spread of infectious diseases.
A Palestine Red Crescent first-aid team
bringing an injured boy to Ramallah hospital on 25 January.
For the crews of the Magen David Adom (MDA), the Israeli
society which provides the country's main ambulance service,
there is the intense strain of living with a campaign of at
times daily suicide bombings and arriving on the scene in
their immediate aftermath; of having to work amidst human
body parts and hysterical bystanders; of making split-second
triage decisions. MDA crews are also on occasion directly
in the firing line. In March this year a suicide bomber walked
into an ambulance station in Efrat, a Jewish settlement south
of Bethlehem, and blew himself up. The volunteer who tried
to stop the bombing was critically injured.
But the MDA's Jerusalem manager, Yoni Yagodovsky, says that
although crews have been exposed to unbearably harrowing casualty
scenarios, sometimes involving children and babies, the stress
is eased by the knowledge that "they have a role - can
do something". Tel Aviv and Jerusalem have also become
laboratories for what might be called extreme first aid. "We
have had some outstanding successes in treating very seriously
injured or mutilated people who would be declared dead just
about anywhere else - no breathing, no pulse, nothing,"
The following is a short list of the numerous first-aid products
and services National Societies offer worldwide.
- Emergency response to crisis
- Manning first-aid posts at large sporting or leisure events
- Hiking and camping safety
- Water safety
- Information and training for the elderly (fall prevention)
- Pet first aid both domestic and farm
- Tips for babysitters
- Healthy lifestyles
- First aid for farmers
- First-aid training for people with physical or mental
- Super first-aid kids
- Work safe
The secret lives of women first aiders under
Soon after the Taliban fled Afghanistan, numerous stories
quickly emerged of women's heroic underground efforts to lead
a normal life under their brutal regime. They had been gathering
in secret to teach children, use make-up, and - thanks to
the bravery and dedication of a male Aghan Red Crescent volunteer
- learn first aid.
Two incidents in particular had made a lasting impression
on Mohamad Anwar, a community-based first-aid (CBFA) supervisor
in the Red Crescent. One was a traffic accident back in 1999,
when he was 24 and an experienced first aider. "I stopped
my motorbike and ran up to the crashed car," he recalls.
"In the back seat I saw a woman who was not moving and
had blood from her head seeping out through her blue burkha."
Anwar wanted to help but a group of Taliban men pushed everyone
away. "I tried to talk to them but they insisted that
what I was doing was against the rules. They told me that
if I could find a woman to help her, fine. Otherwise, go!"
He got back on his motorbike and rode off, desperately worried.
"I was thinking that the woman would die, but if there
had been a female volunteer at the scene she could have been
helped. Why should saving a woman's life be less important
than saving a man's? If the mother is not there, then what
will become of the children? I think that such men forget
that they have a mother, that they were born from a woman."
Two years after her underground first-aid training, Afghan
Red Crescent volunteer Malaka can finally display her certificate
and ID card.
Shortly afterwards, Anwar met volunteers from a village near
Kabul where the night before a woman had bled to death during
childbirth. The male volunteer in the village could do nothing.
"I met the husband of this woman and he cried so much.
He was left alone with eight children."
It was too much; Anwar felt he had to do something. And with
international support, he did, organizing secret first-aid
training for women. In December 1999, he put the first 25
women through a basic course.
In the post-Taliban era, the Afghan Red Crescent has been
quick to start training female volunteers again. It is now
holding two CBFA courses for nearly 60 women in Kabul and
the northern town of Mazar-i-Sharif, with more planned. The
participants are female teachers, who will start working in
girls' schools when they re-open this spring for the first
time since 1996.
Meanwhile, the 25 brave women who trained in secret three
years ago have at last received their certificates and identity
cards. Thirty-five-year-old Malaka says she did not hesitate
to take part, despite the risks involved. "It means a
lot to us to have our certificates," she says. "In
order to influence people's health habits it is important
to be able to show them you know what you're talking about."
The Finnish Red Cross is one of 15
European National Societies carrying out a Road Safety Campaign
in 2002. This campaign focuses on the importance of first
aid in both the prevention of accidents and reducing the number
of deaths and permanent injuries.
Help in more ways than one
Pyhäjoki is a coastal settlement of nearly 4,000 souls
in the remote north of Finland. In the mid-1990s it used to
take ambulances more than 20 minutes to reach emergencies
from their station 35 kilometres away - and they rarely attempted
to treat patients until they got back to the station. All
concerned regarded this situation as unsatisfactory. So the
local branch of the Finnish Red Cross got together with the
fire and lifeboat stations and started a "first response
unit" in Pyhäjoki, Leena Kamaraïnen of the
Red Cross recalls. "The purpose of this unit was to start
life-saving treatment for emergency patients, prepare them
for transport in the ambulance and assist the paramedics with
their duties," she says. And the Red Cross did the first-aid
Within a year the response time had been cut drastically.
Says Kamaraïnen: "When the community noticed how
the Red Cross was helping, everybody wanted to contribute
to the branch, either by donating money or by paying the membership
fee. The number of members doubled."
Red Cross and Red Crescent first-aid training and practice
is about instilling that vital confidence to act: who has
not at some time in their lives stood on the fringes of an
accident and wished they could do more to help? But in a world
perceived to be getting more rather than less hazardous, and
to be changing at an ever faster pace, the challenge for Movement
first aid is to adjust to new realities on an almost daily
basis whilst promoting both minimum technical standards, accommodating
cultural variation and remaining faithful to the humanitarian
spirit of first aid. First aiders are making a difference,
not only between life and death, but also between apathy and
empathy, and solidarity and indifference.
Alex Wynter is a London-based freelance editor and writer.
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