Handling an emergency medical issue

This is an emailed question from a student.

“Salam bro,

Here is a situation encountered involving an injured man. As I walking to the train station during winter time, a cyclist intensely slipped on ice and injured himself. He was bleeding profusely from his brow bridge. A young waitress from the nearby restaurant was beside him not knowing what to do. So I decided to help. The old man seemed completely lost and confused. Although he was sitting on the ground, he was not responding to any of our questions. We made sure to redirect traffic for safety. I decided not to move him.

After I gathered his scattered belongings (glasses, wallet and bicycle), the young waitress went to look for employer for help (the owner of the nearby restaurant). Meanwhile, despite my warnings, the injured cyclist made a few failed attempts to stand up on his own. After finally succeeding, I proposed to remove his bag to relieve him. Suggestion to which I heard his first answer since the accident: no!
At this point I was only holding his arm to prevent him from falling again on the concrete.
Finally, the young waitress quickly came back accompanied by an older woman. Once she was there she started asking him questions… he answered to her. Since she didn’t address me at all, I asked her if I should call an ambulance. She didn’t pay me any attention. She then removed his arm from mine and held him at my place. She then called a bystander who was far away (instead of me who was right there) to come assist her to walk him to her restaurant. They were all gone now and did not think to bring with them his belongings. At this point, I was boiling with anger…but I reminded myself that it wasn’t about me but the injured. I kept the last piece of patience I had to gather his broken glasses, wallet, destroyed bicycle and brought it all to the restaurant. Obviously, I had no intention to stay for the party and continued to my destination arriving late because of this incident.

Although this wasn’t a battle scenario, the Street Medicine training in Malaysia really gave me the confidence to act although people were watching. I did not do much, but would have been clueless on some points without it. I made sure to note the challenges of this little event and here are some questions I had in mind in relation to this:

1. What questions to ask a disoriented injured person?
2. Should we have called an ambulance?
3. When is the appropriate time to move and injured person?
4. Should a bag be removed from an injured individual or could it worsen his/her condition?”


Walaikum Salam,

Firstly, congratulations on your action and willingness to use your training in a real scenarios…that means you understood and took in what was shared.

When you get into any situation the main issue is YOUR safety, not anyone else’s. This may seem strange but think of it this way…if you’re messed up then you can’t help anyone else. So make sure you are ok and the scene is somewhat safe for you to operate without getting injured or killed yourself. Sometimes this may entail dragging an injured person to a yellow zone (somewhat safe) instead of a red zone (high danger area).

That being said, if someone is injured in a trauma accident as you mentioned or any trauma in general and they are disoriented, do not move them to another location except in the case of extreme danger as mentioned above. You can’t assess the extent of internal injuries and what you see externally might be so-so…then you move him, something goes “snap, crackle and pop” and suddenly you have a guy who went from ok to critical and you don’t know it. So, keep him calm, stable in one place, and call EMS ASAP. Many disoriented victims want to move around, get up, find their wife, kid, dog…whatever. Try your best to keep them in place and communicate with them that they have been in an accident, shooting, etc and help is on the way. If they have any dangerous items like a weapon, remove it immediately and store it on you or nearby. If the guy was in a shootout and is disoriented he might think you are the one responsible and attack you! If he has weapons accessible it could go very bad for you. Thats why I always do a “trauma frisk” on ANYONE I get who is disoriented to check for injuries AND weapons in one go. I showed that frisk in the Martial Medic video.

Another important point, the more in control you are the more they are likely to obey and bystanders are also. I mentioned in the Iron Sultan about the natural disaster situation I faced in Taiwan when I arrived and I explained the concept of “defaulting to natural command structure”. If you take control of the situation and people see you commanding the situation, there could literally be blood everywhere and people would still listen to you and obey. In a shitstorm, people will obey the strongest most capable person who can resolve the situation. Black, white, educated, Irish, Muslim, Shinto, etc, etc…all goes out the window. Capable, strong and focused will win over the people.

Lastly, don’ t assume that people who are injured are really injured. The whole situation could be a trap for you to get involved but the actual target is YOU and this setup for the hero to help out is just that…a setup. Use your common sense and vigilance, especially if you’re someone who has an important position, valuable information, dangerous occupation, known to carry or receive valuable items, etc. You could be the target and because they researched you and your coming and goings and training they might think you are susceptible to such a situation. Kidnapping setups are often done this way in Africa and South America. A raped girl, distressed female, child unaccompanied, etc. Be careful. If it feels wrong and feels fishy, get out! I’d rather disappoint the world a million times then let the world disappoint me even once.