3.1 — How to Be Useful in a Medical Emergency

The most encouraging fact in this Part, and it should be first.

Bystanders save lives routinely, with no equipment and almost no training, by doing a small number of simple things.

Chest compressions. Pressure on a wound. Calling early. Putting somebody on their side. Staying.

None of it requires medical knowledge. All of it requires having read this once.

The universal sequence

Six steps, and they apply to every situation in Part 3.

1. Check that you are safe

Traffic, electricity, water, smoke, gas, an unstable structure, a hostile person.

Every time, before you approach. A second casualty removes the help.

2. Check the person

Tap their shoulders firmly and speak loudly. Are you all right? Can you hear me?

Three possible answers, and they route the whole thing.

They respond. Talk to them, find out what is wrong, keep them still and warm, get help.

They do not respond but they are breathing normally. Recovery position (below), and get help.

They do not respond and are not breathing normally. Cardiac arrest until proven otherwise. Go to 3.2 immediately.

3. Check breathing, for ten seconds

Tilt the head back gently with one hand on the forehead and two fingers under the chin. This lifts the tongue off the back of the throat, which is the commonest airway obstruction in an unconscious person.

Then look at the chest, listen at the mouth, and feel for breath on your cheek. Ten seconds.

And the critical warning: agonal breathing.

In the first minutes of cardiac arrest, many people make occasional gasping, snoring or groaning noises. It looks like breathing and it is not.

It is one of the main reasons bystanders do not start compressions, and it costs lives.

If the breathing is not normal, regular and effective — treat it as absent.

4. Get help coming

112 in India for the unified emergency response, or 108 for an ambulance in most states.

Say: the location first, what has happened, how many people, and whether they are conscious and breathing.

Put the phone on speaker and keep it near you. The dispatcher will talk you through what to do, and dispatcher-assisted CPR measurably improves outcomes.

And if others are present, delegate specifically (1.1): point, name, task, confirmation.

5. Do the fastest-acting thing

Not breathing: compressions (3.2).

Bleeding heavily: press hard (3.4).

Choking and cannot speak: back blows and abdominal thrusts (3.4).

Unconscious and breathing: recovery position.

6. Stay, watch, and reassess

Things change. A person who is breathing can stop. A person who is talking can deteriorate.

Recheck breathing every minute or two, and keep them warm — a blanket, a coat, anything between them and the ground.

The recovery position

The single most useful thing to know after CPR, and it takes thirty seconds to learn.

For anybody unconscious and breathing normally.

**Why: an unconscious person on their back can be killed by their own tongue or by vomit. On their side, the airway stays open and fluid drains out.

How, with the person on their back and you kneeling beside them:

Place the arm nearest you out at right angles, elbow bent, palm up.

Bring the far arm across the chest and hold the back of that hand against their near cheek.

With your other hand, pull the far knee up so the foot is flat on the ground.

Pull on that knee to roll them towards you, onto their side.

Adjust the upper leg so hip and knee are at right angles, which stops them rolling further.

Tilt the head back gently to keep the airway open.

And then recheck breathing regularly.

If you suspect a spinal injury, the airway still comes first — an open airway matters more than a theoretical spinal risk, and this is the standard guidance.

What to say

And it is not incidental.

Tell them your name and that you are staying.

Tell them what you are doing and why.

Do not promise it will be fine. Say something true: the ambulance is coming, I am not leaving you.

And keep talking even if they seem unresponsive. Hearing frequently persists.

What not to do

Six, and they are all common.

Do not move somebody unless they are in danger where they lie.

Do not give food or water to anybody who is confused, drowsy, or may need surgery.

Do not put anything in the mouth of somebody having a seizure (3.5).

Do not remove an object that is embedded in a wound — press around it, not on it.

Do not use a tourniquet as a first response for ordinary bleeding. Pressure first (3.4).

And do not drive somebody to hospital if an ambulance is available and the situation is serious. The ambulance begins treatment on arrival; a car does not, and a person can deteriorate in the back seat with nobody able to help.

The exception is where no ambulance is realistically coming, which is a real situation in many places — and then drive, with somebody else in the back with the patient if at all possible.

The legal question

Because it stops people helping and it should not.

Many jurisdictions protect bystanders who help in good faith.

In India, there are Good Samaritan protections for people who assist road accident victims, intended to remove the fear of harassment or liability that historically stopped people stopping.

And practically: the risk of harm from a bystander doing imperfect compressions is very small, and the risk of harm from nobody doing anything is total.

Imperfect help beats no help, in every scenario in this Part.

What to have

Three things, and they cost very little.

A basic kit (9.2): gloves, a large dressing capable of pressure, a bandage, scissors.

The numbers written down where somebody else can find them.

And any household-specific item: an inhaler, an adrenaline autoinjector, a glucose source — and everybody in the house knowing where it is and how it works.

What to do with this page

Learn the sequence: safe, check, breathing, call, act, stay.

Learn that agonal gasping is not breathing. It is the single most consequential misinterpretation in this Part.

Learn the recovery position tonight. Thirty seconds, and practise it once on somebody.

Put the phone on speaker and let the dispatcher help you.

And know that imperfect help beats no help. That sentence is what gets people to start.

Next: 3.2 — CPR, which is the highest-value fifteen minutes of reading in this book.