Professional responders who are first to arrive at a mass casualty incident (MCI) face a complex and potentially overwhelming challenge. It’s possible the first to arrive may be an inexperienced responder who will have to make decisions quickly and may lack mental models to help drive their behaviors. Even in a well-coordinated response, the professional responders may not be able to treat all the injured at the same time, and so they must triage and prioritize the victims.
自发的志愿者经常勇敢地一步fill the gap without being asked, but their courage and commitment often adds complexity to an already chaotic and challenging situation. Recent MCIs demonstrate that volunteers are often willing to help in a variety of ways. The additional support can make a significant difference in the response, and can help saves lives. Current policy and training don’t encourage professional responders to engage and leverage the public in this manner.1
The initial professional responder (IPR) is defined as “the initial professionally trained and legally recognized responder to arrive at the scene of an event.” It is usually a member of the police, fire or EMS. An IPR arriving on scene at any complex event is often the immediate center of attention for volunteers and victims. The IPR is seen as the legitimate authority and expert to turn to.
This can create a significant amount of stress on the IPR, as well as providing the IPR with an important amount of informal power. The IPR is expected to take charge, make decisions and provide information under the most challenging of circumstances. A simple and straightforward method of trying to bring order to the chaos is needed to allow the IRP to make decisions and manage the incident effectively.
Recognition of the capacity for volunteers to help has led to a number of new initiatives aiming to train and empower volunteers. Simple yet effective medical techniques and initiatives have been developed, such as Stop the Bleed, Be the Help,2直到帮助到达。3
Current training for professional responders focuses on reducing the complexity and liability of a response to an MCI by “clearing” the scene of spontaneous volunteers and bystanders. This approach doesn’t recognize the reality of spontaneous volunteers, nor does it allow the IPR to take advantage of the skills and potential support spontaneous volunteers can provide.Volunteers are critical to the initial response in many types of emergencies, from terrorist events to vehicle accidents to mass evacuations.4在这些事件中，专业响应者需要了解“谁能提供帮助”。
志愿者支持协议
A team from the National Preparedness Leadership Initiative (NPLI) at Harvard University studied the problem of volunteers at emergencies. They believe if IPRs are trained in using a simple protocol to better control and leverage the capacity and support of “spontaneous volunteers,” it will lead to better outcomes. These outcomes could be fewer deaths and injuries, faster casualty evacuation, and more effective scene control at MCIs and other emergency events. The success of this initiative is the development of a protocol and supporting training that allows professional responders to be knowledgeable and effective in coordinating the support of volunteers.
志愿者出于各种原因协助现场娱乐，但是无论他们的动机如何，技能，能力和承担某些任务的意愿都会有很大差异。当知识产权出现时，“自发志愿者”（SV）已经在某些方面有所帮助。“愿意的志愿者”（WV）可能处于近距离状态，但正在等待某人的社会提示或领导才能帮助参与和指导他们的支持。现场的那些人将无法或不愿意支持这些努力，他们被归类为“旁观者”。他们也可以通过使用协议来处理它们，以最大程度地提高愿意的志愿者的有效性，同时减少被动旁观者的影响。（见图1）
For ease of memory and implementation, the mnemonic “SCAN” was developed to describe the steps of the protocol,:
- SAFETY：雇用志愿者安全吗？
- Call for assistance: “Who Can Help?”
- Assign tasks and duties
- Network: Communicate and provide updates to keep people informed.
Safetyof professional responders, volunteers, victims and the public is of primary concern. There may be conditions where the deployment of volunteers is a bad idea. Areas near a hot zone of a hazardous materials incident, or at the scene of a still active violent event. In such cases, even professional responders must consider the risks and take appropriate actions to ensure the emergency doesn’t escalate further. Once the scene is safe enough for volunteers, the IPR should quickly look to leverage willing volunteers and support those spontaneous volunteers who have already engaged and are helping victims.
一个简单的请求帮助(e.g., “Who can help?”) will likely yield a significant additional outpouring of support. As studies have shown, more than 70% of the time volunteers will intervene and assist even when no one asks for their help.5
A further simple set of questions begins to sort the group of volunteers. Once sorted, those groups can be分配的任务appropriate to their skills and abilities. The term “volunteer triage” has been developed to help describe the simple steps in assessing and assigning tasks to volunteers.
The NPLI team’s research identified those tasks most needed during initial stages of an MCI. A wide variety of the tasks could be assigned to volunteers depending on the situation and event. For simplicity’s sake, the tasks have been broken up into three general types based on the volunteer’s skills and capability: medical support, scene safety and general scene support. (Figures 2 and 3 outline the volunteer triage protocol.)
There are a wide variety of tasks that can be assigned to volunteers: scene safety and site access control, bleeding management (e.g., applying tourniquets), evacuation of the injured, delivery of supplies and equipment, being the lookout for emerging hazards or threats, documentation, directing traffic, photographing and recording the scene (e.g., crowd and vehicles), as well as helping to conduct searches.
There are also tasks best left to other trained response organizations, including evidence collection, cleanup of potentially hazardous waste, detaining suspect(s) and other technically demanding work. The project team at the NPLI used an在线调查从广泛的紧急服务人员和第一响应组织中收集有关潜在志愿任务的反馈。
The professional responder managing the volunteers should continue tonetwork and communicate与志愿者一起提供信息，鼓励和帮助。这创造了共同的情境意识。这可能会导致更有效的反应，并可以减少对受害者和志愿者的潜在心理和情感影响，因为他们对正在发生的事情有一定的了解。3
Learn to Leverage Volunteers
鉴于扫描协议的相对简单性和对其开发的反馈，该项目的目的是将培训和协议纳入所有紧急急救人员培训的一部分。培训可以在课堂讲座或通过在线或混合平台上进行。然后，可以在包括桌面和现场练习以及全面MCI模拟在内的各种培训活动中练习扫描协议。还应考虑将扫描协议纳入事件命令培训中。
紧急管理专业人员对项目工作和扫描协议的最初反应和反馈是积极的。该课程标题为“谁能提供帮助？”，在2019年4月和2019年5月期间，正在向马萨诸塞州的知识产权，警察，消防和EMS部门教授。
该课程旨在在一小时内交付，并从参与者那里收集了课前和课后的调查。这项反馈将帮助NPLI的团队进一步加强该计划，以便将来向全国和全球的知识产权提供交付！
有关更多信息或参与该项目的持续评估，请联系WHO可以帮助团队whocanhelp@nmetc.com.
References
1. Ashkenazi I, McNulty E, Marcus LJ, Dorn BC. The role of bystanders in mass casualty events: Lessons from the 2010 Haiti earthquake.J Def Stud Resour Manage. 2012:1(2).
2. Callaway DW, Smith ER, Shapiro GS. Be the help.灾难医学和公共卫生准备. 2018;12(1):155–156.
3. Department of Homeland Security. (n.d.) Until help arrives. Retrieved April 19, 2019, fromhttps://community.fema.gov/until-help-arrives.
4. Harris C, McCarthy K, Liu EL, et al. Expanding understanding of response roles: An examination of immediate and first responders in the United States.Int J Environ Res Public Health. 2018;15(3). pii: E534.
5. Faul M，Aikman SN，Sasser SM。紧急医疗服务到达之前的旁观者干预：比较跨医疗紧急情况的援助。Pre -hosp紧急护理。2016;20(3):317–323.
AUTHORS
Bradford Newbury, MPA, NRP,is a captain/paramedic with the Stoughton Fire Department in Massachusetts. He also serves as the associate director of EMS education at the Beth Israel Deaconess Medical Center Fellowship in Disaster Medicine.
Tim Fox, MS,是美国北部司令部国防部的私营部门和非政府组织联络人，特别是在灾难响应领域。
Anita M. Sher, MS,is assistant commissioner at New York City Emergency Management (NYCEM), where she helped to create and now oversees the NYCEM Academy, the agency’s training arm. The NYCEM Academy trains over 3,000 people each year, including NYCEM staff, government agencies, non-profit organizations and private sector partners in all areas of emergency management and emergency operations.
Shane Schreiber，马萨诸塞州，医学博士,有超过30年的经验in crisis and emergency management and is currently serving as the managing director of the Alberta Emergency Management Agency in Edmonton, Alberta, Canada.
Michael R. Kent, MPA,is chief of police in Burlington, Massachusetts. He’s been a police officer for over 37 years and is an executive board member of the Massachusetts Chiefs of Police Association, treasurer of the Northeastern Massachusetts Law Enforcement Council, and a member of the International Association of Chiefs of Police and the Police Executive Research Forum.
Detective Captain Michael Lyver, MS,is a 26-year veteran of the Massachusetts State Police, currently assigned to the Division of Investigation Services.
海军少将安东尼”Jack” Vogt, MA,负责美国海岸警卫队计划和政策，支持紧急管理，执法，国防任务，泄漏响应，水道安全和救援行动。
Mobarak Al Mulhim, MD, MBA, FRCPC (EM & CCM),是一名紧急护理医学医师。他是哈佛医学院贝丝以色列执事医学中心的灾难医学研究员和贵族医学研究员。
