Overview of citizenAID by Keith Porter

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You deliver first aid to hopefully train people to deal with this sort of situation. citizenAID was created to empower the public to save lives, and they may not need to have done any formal training to do that. Our mantra is you don't have to be trained, but great if you are trained and you don't have to the equipment, it's okay to improvise. And if people would only adopt this, then we would be able to save more and more lives. And what I'm going to talk about in citizenAID, I'm going to talk about blasts and knife wounds and so on, but all the skills, as you will appreciate, I'm going to talk about are all transferable to the two car RTC that happens outside your house tomorrow afternoon. We woke up in this country really in 2017. citizenAID was born in the January of 2017, and launched in then.

But we then have March the 22nd, Westminster Bridge, 49 people injured, four dead. You then have the Manchester Arena bombing, which I have already alluded to. We then have the Borough market scene, 11 dead 40 injured and so on. And then we have the underground incident where fortuitously no one was actually killed in that. This very much brings it home. And you might say, "Well, we have not had any bombing since then."

They have not gone away. It just so happens we have had things like COVID and other things. The potential for a resurgence of mainland bombing, mainland instance, is still very much there. Let's just look at the Westminster incident, okay? And quite often, I do talk to the general public, and would say, "What would you do?" I'm not going to go around and ask you questions because you would have your own ideas and be knowledgeable. When you look at this incident, 22nd of March '17, then the car drives onto the pavement on Westminster Bridge. It drives along that pavement. It's hitting people as it's going along that pavement, it crashes into the railings. The guy jumps out and he stabs, fatally stabs a police officer. And the perpetrator is eventually shot dead.

In 82 seconds. Okay. So 82 seconds is the time from the previous slide to this side on average, looking through, there are six dead, 35 plus injured. The car's going at 76 miles an hour and there are about 1500 witnesses. Doctors and nurses ran out of St. Thomas's Hospital, which is here over there to help. And they got there and they were helpless. First thing is they didn't know what to do in terms of the basic First Aid. And secondly, where's... I have not got any kit, because they are all used to working in a hospital. So our mantra of ideally be trained, First Aid trained, but if not, if you had the Citizen App, which could be on your phone, then it would tell you what to do and it's okay to improvise. And simple things save lives, I have been saying this and you too told me this, open the airway and stop the bleeding. So I could have gone home as you know.

Common themes things are seen in all these incidents. I just want to just develop this a bit. This could be a shooting, stabbing, explosion, a vehicle attacked, could indeed be an acid attack nowadays. And then it happens. And you must follow really the police fundamental advice on this, which is run, hide, tell. If you can run further away from this, then you don't need to hide. But if you can not get away from it, then you need to hide and you need to communicate with the police. And within citizenAID we would add... And when safe to do so treat, okay? And when safe to do so, treat. Run, hide, tell. And when safe to do so, treat. So here's a situation, an incident, whichever one you like has happened. The security services are all dealing with this threat. You are going to read all about that in the Manchester report.

There's a treatment vacuum and there's a management vacuum, I.e. Casualties aren't being treated and no one has got control of the situation at all. And people are dying from blood loss and there is no control. There's no formal approach, there's no logistical approach, there's no triage, etcetera, going on. And what we aim to do with citizenAID is to empower the public to deliver both of those. To stop the bleeding, to get control of the scene and to hopefully save lives.

And at the end of this, we should generate more salvageable patients. Am I talking nonsense? Am I talking the truth? All these skills have been evolved from practice with the British military in the past. And we know by instilling these drills into the military, that they save lives. That is why those figures from Afghanistan and Iraq are so, so good. The impact to save lives rests with the public in this sort of situation. In fact, it always rests with the public, whether I'm talking about your cardiac arrest or the guy who gets stabbed in Tesco's tomorrow when you are doing your Saturday shopping. Unless someone is there, the chance of survival are nonexistent.

When there was a big exercise in Mary Hill, as alive as it could be, so casualties, the SAS coming in to help and so on, it took 95 minutes before a paramedic could be allowed in to treat the patient. And the reason for this is the situation's got to be made safe. If it's a bomb, you got to make sure there are no more bombs in the area, secondary devices. And if it's a shooting, you have got to make sure you have dealt with the perpetrators. So there's always this delay. So the impact is with the public to save lives. This has all been learnt from the military. This is from the second World War. I'm just going to read to you, after an air attack, the first eight parties will reach the wounded within a few minutes, even such a short time counts. Same message, historic message. The man or woman on the spot can save lives by immediate and proper action. The first and most important duty of a civilian helper who first reaches a casualty is to stop the bleeding. So none of this, as you know, is new. It's all been historical practice through the military, but our public at this moment in time are not really embracing this.

So we have to take the message from our military experience and deliver it to civilian life. So let me just talk a little bit about citizenAID. How many of you have got the citizenAID app on your phone, by the way? Raise the hand a bit higher. Very good. That's about 20% of you. So that is really... That's good news actually and thank you for that. So it's a system on the app. You can choose whatever one of these that you need. A lot of the initial bit is about management and then onto treatment, as I will share with you, you can have a pocket guide. And can I tell you that whilst you may have it on your app, if you are trying to teach... If you know nothing about First Aid and you are trying to treat someone on your app, you have got to keep giving attention to your app. So you are moving away from your patient.

So we know when we did an exercise in here for the people who prefer to have the pocket guide because they can lay it out by the side and they can just go through the drills and the process based on the pocket app. So there you are. There are some new additions in here. And this is our newer version that's been updated. And that is the system in a nutshell here, is what to do the circumstances and this is the treatment which I'm going to elaborate on a bit. So that is your preparation and response. That's your treatment. And within the app, there are exercises to follow. Some built-in training, but we hope very soon there will be a more effective way of training the general public. Which I think is called you people because we are living in dangerous times. We provide, for example, quite a lot of training material.

This is general advice, but we have now got as far as books for kids. We believe that training children, training adolescents is the way to impact change. A lot of adults will never necessarily accept the need for change. So we have got the educational material and support, which we hope you would perhaps embrace. So the whole of the system is icon driven largely, and that is because it then makes it easy based on icons to translate it into another language, so it can be internationalized. So in fact, this system is available and information in Ukrainian actually even in Russian, because we have not got... You can think what you like about the Russians, but most of the Russians are probably decent people. It is Putin who is the main problem. And people deserve the chance to be able to save lives. So it's got a number of translations. So you can choose whichever one you like and it will take you through a guide.

And you go through your casualty first look, it just takes you through a systematic thing, slightly different to perhaps what you might do. But if you are not breathing, it tells you what to do and what you need to do. If it's a single casualty, you will attend to that casualty. But if someone's not breathing when you first see them, you would probably turn them over into a airway protective position and go on to the next patient. Because if you start doing BLS on this patient here, what about the other 55 who are bleeding to death? So it's all about triage and priority. And you can go through... Now I'm going to illustrate a shooting. And this is in the citizenAID system. We don't want to show gory pictures, I showed them to you earlier on because you are first aiders and you would get that message.

Well, I'm not going to show pictures for example of that guy dead with a traumatic leg amputation. We don't need to frighten people, we need to take them with us, particularly youngsters. So we have got a... This is a town called Good Citizen Ham. Okay? And welcome to Good Citizen Ham. And let's go to the shopping center, the Grove Shopping Center. And here we are on a Saturday afternoon, and then suddenly this happens. Run, hide, tell. Now you have actually got away and you are safe. You can go into the app and see what to do where it says active shooter and follow the system. It will tell you if you are going to hide, then you need to hide in a safe way. It shows you how to do this in the app and as you... There are some people who are hiding right at the front, so they might be seen by the perpetrator. Whereas you should be protect yourself as much as you can. And we all know... I mean, you have all watched the movies where someone's made a noise upstairs and they have been shot by the guy downstairs.

But if your mobile phone goes off, then you are telling people where you are. So all of these systems are designed that your mobile phone should be turned to silent. Follow the police advice, which is what I have said, run, hide and tell, and then go through the system. I don't want to spend too much time on it, but we really make an emphasis on that. There's an exercise on who's doing it right and who's not doing it right in terms of hiding. And then there's a message to the 999 services. And in conjunction with the emergency services, we have set up what's called a slide message, which I'll come back to communicate to the ambulance service. So you are ringing the ambulance service.

So S the situation, L the location, I the injured numbers, D for danger and E for emergency services. Do you have any help there, or... So that the ambulance service can build a picture and the response they need to generate. And then you go through your triage. You probably know a lot about triage. This here is just me moving this across to there. But you begin to triage. It's a single or last casualty. If it's a single casualty, then you know you are not going spend a lot of time on the single casualty. If it's multiple casualties, you will identify severe bleeding. Yes, pack the wound, Tourni-Key, they are a priority one, not bleeding. Are they walking? Yes. Corral them. Perhaps get someone to keep them all together, but you don't need to do anything else. Are they talking but they are not walking?

Yes. You just reassure them because you have excluded major bleeding. And obviously, as they are talking, they are not unconscious. And if you are not bleeding, you are not walking, you are not talking, and you have got low signs of life, then in a multi casualty situation, you are presumed dead. And if you look at and get used to this system, it's very very simple and very practical. And then so there is a triage exercise here. He's dead. He's a P1, he's a P2 and over there can move away. And then you get the answers. And then, if you have only got one casualty have not been through, then obviously you can treat that casualty. But essentially whatever problem you find, you can use the app just to click on the problem and it will take you through.

So if someone's got broken bones, click that it will tell you what to do. If the patients burnt, click that it will tell you what to do, in a life-threatening to less life threatening priority. The guy here had a 20 minute training course. This is done in Harvard on simulated casualty. And he was effective, very effective at saving lives with very little training. We stress very much it's okay to improvise in terms of a Tourni-Key. If you have got a commercial Tourni-Key, that is absolutely fine. But we accept improvisation. So explosion. But we are in Goodcitizenham. Once again, we are going to a game of football. And interestingly enough, no one's noticed this guy here, by the way, who looks a bit suspicious at a football match and then there is an explosion, you can run, hide, tell, follow what the app says and then it's a control and act.

So you get control of the scene and then you are going to assess the scene. You are going to communicate what's going on and then you are going treat. So this system works very well. So this is in terms of control, consider your own safety at all times. Be alert for any potential dangers. See if you can get control of the situation whatever that means. Try to free it from any danger. Use all bystanders as appropriately. And if there is walking wounding, just try and corral them. That gives you some control. And then it tells you what to do if there are weapons around. And then tells you through to how to assess the scene, how to call the emergency services, how to triage the patients.

And then, let's look at treatment in a bit more detail. Only treat when it's safe to do so. And then you go through this. So the first look, identify the injured, follow the system, multiple casualties, unconscious, seemingly unresponsive, put them in the recovery position, move on. Single casualty CPR, ADF available, multiple casualties, no CPR, move on. Severe bleeding, it's all about pressure. Superficial the most and a big deep wound is to get that pressure on top of an appropriate dressing desirably. But you can improvise at that point of bleeding deep in the wound and you will hear more about clotta dressings and so on later, which are a new generation. But reassuring the general public, it's all about pressure and improvisation is perfectly okay.

And so we go onto Tourni-Keys, again, save lives. The whole system takes you through that. I'm not going to take you through it myself now. Record the time that the Tourni-Key was applied. That's helpful when the patient goes into a hospital. It then allows if the two patients had Tourni-Keys on similar limb injuries, the guy who's had the Tourni-Key on the longest probably should be the first person to go to theater. And then we have developed a simple Tourni-Key, which could be in your purse, in your pocket, on you. Which again, you will see Mike at the back will tell you all about that.

The non-responding patient I have already alluded to. And then we go onto fractures and then we go onto burns and acid burns, cool for 20 minutes, etcetera. And then protecting the patient from the environment. So if they are outside this time of year, keep them warm, etcetera. And then it's a missed handover, so the mechanism injury, the injuries found, the signs and symptoms, the treatment given and the documentation. And you can pass that on to the paramedic when he arrives. So this is Simon, he's been stabbed. He has a large wound on the front of his thigh. He's conscious. His pulse is fast. I have packed the wound and he is applying pressure. That would be amazing if we could get that done. There are no challenges to teaching people about citizenAID, the Good Samaritan Act fundamentally covers everyone for doing first aid as you are aware.

We have free training, I'm going to finish now, but pretty quickly. But there is free training materials, free apps that you can download. And if you look through the system, you can recommend those to people you are teaching. It is all there. We have pushed on with our education. We have had parliamentary support through Lord Jordan in the House of Lords as you can see there. We have created our own contextualized programs to suit age-related kids. So for key stage three and four, this is all about the lion that goes in the school run, hide, tell and simple treatment. We have made bespoke teaching material for organizations. We brought one for the House of Lords and the House of Commons, though I understand there was some suggestion that Tourni-Key was going round Liz Truss's neck, but I'm not sure I was allowed to say that at this moment in time. But the St. John have helped to create this, and this is our translated version into Ukrainian.

So I hope I have given you a bit of a flavor of what citizenAID is about. Do download, have a look at the system, see how it works. You will learn a lot more. Do take advantage of the free educational material though. But at the end of the day, people are dying because of problems with airways and problems with bleeding. And you are the solution, whatever the situation you are in. And I'm happy to try and answer any questions. Thank you.