The First Five Minutes After Someone Is Hurt

Why this matters

Most serious injuries on a residential job are decided in the first few minutes, and most of what decides them is not medical skill. It is whether anyone checked that the thing that hurt the first person was still live, whether someone actually called, and whether the one or two actions that matter got done while everyone else stood in the doorway. A crew that knows the order does those few things in the right sequence without discussing it. A crew that does not spends the first two minutes arguing about whether to drive him to the hospital.

This card owns that sequence. The individual actions (stopping bleeding, CPR, cooling a burn, flushing an eye) each have their own card; this one is about what comes first, who does what, and what waits. It follows mainstream American Red Cross and American Heart Association guidance. It is not training: a card teaches the order, and hands-on certification is what makes someone a responder.

The order, and why it runs this way

Four moves, in this order:

1. Check the scene for whatever hurt them, because it can hurt you.
2. Call, or send someone to call, emergency services, with a location responders can find.
3. Give the care that matters in the first minutes, which is a short list.
4. Keep the person still and warm, watch their breathing, and wait for responders.

The order is not arbitrary. Scene comes first because a second casualty doubles the emergency and removes a helper; the classic way a coworker becomes a casualty is by touching the first one. Calling comes before most care because an ambulance takes minutes to arrive and nothing you do on the floor replaces what arrives in it, so the clock should start as early as possible. The exception is when you are alone with someone who is bleeding heavily or not breathing: then you put the phone on speaker and do both at once, because a minute without pressure on a severed artery is a minute the call cannot give back.

Scene: the hazard is usually still there

The injury tells you what to look for. Name the hazard and the specific action before anyone moves toward the person:

• Electrical contact. Do not touch them. Open the breaker or disconnect, or unplug the cord, and only then approach. A downed or overhead utility line is a call to the utility and a wide berth, not a rescue. See related: Electrical Shock First Response.
• Gas odor or a suspected leak. Everyone out, no switches, no phone used inside, call from outside upwind.
• A crawlspace, attic, pit or tank where someone collapsed for no visible reason. Assume the air did it. Do not go in after them. See related: Rescuing Without Becoming the Second Victim.
• Running equipment. Stop it at its disconnect, not at a thermostat or a remote, before reaching into a blower, a door operator or a drive.
• Stored energy. A spring, a pressurized line or a suspended load that has already moved once can move again; stay out of its path until it is secured.
• Traffic. A tech hurt at the curb or in a driveway gets a vehicle with hazards on placed between him and the street.

If you cannot control the hazard, you do not go in. That is the hardest instruction on this card and the one that keeps the count at one.

Call: start the clock early

Send a specific person, by name, with a specific instruction: "Marcus, call 911, tell them severe bleeding, give them this address, then come back and tell me they are coming." "Somebody call" produces either nobody calling or three people calling. If there is an AED (automated external defibrillator) on the truck or in the building and the person is unresponsive, the same sentence sends someone for it.

What to say to the dispatcher, how to describe the access, and how to get the ambulance to the right door belong to a sibling card. See related: Calling 911 From a Job Site So They Find You. The point here is timing: the call goes out in the first minute, before the care has settled into a rhythm.

Care: the short list that changes the outcome

Five situations call for action before responders arrive, because waiting on them costs tissue or life:

Everything else waits. A deformed wrist, a gash that is oozing rather than flowing, a sprain, a minor burn already cooling: these get a covering and a calm voice, and nothing more until responders or a clinic. The common failure is a crew spending three minutes splinting an arm while nobody has checked whether the person is breathing well.

One move from the table needs its boundary stated: you move a person with a possible spinal injury only if leaving them where they are is the greater danger (fire, rising water, an atmosphere you cannot control), and then as little as possible, keeping head, neck and body in line.

Still and warm: what to do while you wait

Once the urgent action is under way, the job becomes preventing things from getting worse:

• Lay them flat and keep them there, unless they are struggling to breathe and want to sit up, in which case let them. An unresponsive person who is breathing normally and has no suspected spinal injury goes on their side (the recovery position) so the airway stays clear if they vomit.
• Cover them. A moving blanket or a jacket under and over them. Shock in the first-aid sense is the body failing to circulate enough blood, and cold, a concrete slab and fear all make it worse.
• Nothing by mouth. No water, no aspirin, no food. Water is the most common request and the one to refuse, because a person who may need surgery or who may vomit should not have anything in their stomach. The exception is a conscious person with known diabetes showing low blood sugar, which has its own card.
• Watch breathing and talk to them. Note whether they are getting more confused, paler, or slower to answer. Those changes are what you tell the paramedics.
• Write the times down on anything: when it happened, when 911 was called, when a tourniquet went on. Responders will ask, and nobody remembers accurately afterwards.

Roles when two or three people are present

The card below is what a shop posts on a visor or the back of a van door. One person per role; with only two, the caller takes runner and meeter in turn.

  ON SCENE WITH 3        ON SCENE WITH 2
  -----------------      -----------------
  CARE: stays with       CARE: stays with
  the person, does       the person, does
  the urgent action,     the urgent action
  never leaves
                         CALLER: calls 911,
  CALLER: calls 911,     then gets kit and
  stays on the line      AED, then goes to
  within sight of CARE   the street at the
                         2 minute mark if
  RUNNER: gets kit,      the dispatcher
  tourniquet, AED,       allows
  blanket; then meets
  the ambulance at       ALONE: phone on
  the street             speaker, care and
                         call together
  WHOEVER IS SENIOR: decides, says it out loud

Two things about this layout. The CARE role never leaves the person, even to grab the kit, because a hand on a wound is doing more than a second trip to the van. And somebody says out loud who is doing what, because three people who each assume the others have it is the most common way a call goes unmade.

A worked case: the saw that kicked

A three-person remodel crew is cutting out a damaged subfloor. The helper's reciprocating saw binds in a hidden joist hanger, kicks, and the blade opens the front of his left thigh about a hand's width above the knee. Blood is coming out fast and pooling on the plywood.

0:00 to 0:15, scene. The lead tech sees the saw still in the helper's hand, trigger released, cord still plugged in at an outlet across the room. He tells Dana, the other crew member, to pull the plug before anyone kneels in reach of the blade. The hazard is small, but a dropped saw that restarts when somebody grabs it for leverage is exactly how the count becomes two.

0:15 to 0:45, call and roles. The lead takes CARE. He says: "Dana, call 911, severe bleeding from the leg, then grab the red bag and the tourniquet from the van." Dana is CALLER and RUNNER both, because the homeowner is the third adult in the house and is asked to open the front door and put the porch light on.

0:45 to 2:30, the urgent action. The lead presses hard on the wound with a towel and his body weight. It soaks through in under a minute. Dana returns with the tourniquet at about 2:00 and the lead places it on the thigh, a few inches above the wound and not on the knee, and tightens it until the bleeding stops. Dana writes the time on the tape: 2:30 after the cut. The steps for that are on their own card; what this case shows is that pressure went on in the first minute and the tourniquet followed when pressure was visibly failing, rather than waiting for the kit before doing anything.

2:30 to 5:00, still and warm. The helper is pale and cold to the touch. The lead keeps him flat on the floor, gets a moving blanket under his shoulders and over his chest, and refuses the glass of water the homeowner brings. Dana stays on the line, relays that a tourniquet is on and the time, and is told to send someone to the street. The homeowner goes. The ambulance pulls up at about the eight-minute mark to a person waving from the curb.

What changes the answer. Alone, the lead would have called on speaker with his other hand already pressing the wound, and not left to get the tourniquet until the dispatcher told him to or the pressure was clearly failing. With an oozing cut instead of pooling blood, the sequence would still be scene and call, but the care would stop at pressure and a dressing. And if the helper had collapsed with no visible injury in a crawlspace, the first move would have been not to go in at all.

The failure this case avoids. The instinct in a house full of tools and a truck in the driveway is to load the person into the van and drive. With life-threatening bleeding that trades professional care that is minutes away for a driver who cannot hold pressure, through traffic, to a door that may not be the trauma entrance. See related: When to Go to the ER Versus Urgent Care.

How to tell you got this right

After any injury, the person who was senior should be able to answer four questions in one breath: what hurt them and was it controlled before anyone touched them; who called, and at what time; what the one urgent action was and when it started; and who met the ambulance. If any answer is "I think someone did," that is the gap to train. The written report comes afterwards and belongs to its own SOP.

References

• American Red Cross and American Heart Association, current first aid and CPR guidelines (the basis for the care table and the still-and-warm steps).
• See related: Calling 911 From a Job Site So They Find You; What OSHA Requires for First Aid at a Small Shop.
• See related: First Aid + AED on the Jobsite; Rescuing Without Becoming the Second Victim.
• See related: The Injury Response SOP; Accident and Incident Reporting SOP.