“Hostile Environment Awareness Training (HEAT) for journalists” is a ten-part series developed by Reporters Without Borders (RSF), Silk Road Training and Exile Hub. This fifth article outlines how to assess casualties and manage catastrophic bleeding in high-risk environments.
Hostile Environment Awareness Training (HEAT) is a comprehensive safety training course covering core areas of preparedness for journalists working in high-risk environments. It includes preparedness for civil unrest, conflict zones, hostile environment first aid, vehicle safety, and digital security. Journalists may be the first to encounter injured individuals in conflict zones, and their ability to carry out a structured assessment and manage injuries until medical professionals arrive can be life-saving.
1 – Assessing the situation
Before you can provide aid, you must ensure your own safety. A calm, structured approach is essential.
- Stay calm. Stop, think, control your breathing and work methodically.
- Check for danger. Assess risks to yourself and the injured person in your surroundings before approaching.
- Understand the injury. Identify where and how the person is hurt, and whether moving them is safe. Do not move them if you suspect a head, neck, or spinal injury.
- Call for help. Communicate your location and the situation to emergency services or your designated field contact. Initiate planned evacuation procedures, such as calling an ambulance, alerting your driver, or activating a security team.
Then, use the DR-CAB sequence to guide your response:
- Danger: Scan again the area for immediate threats.
- Response: Check if the injured person is conscious and responsive. Use the AVPU scale (alert, verbal, pain, unresponsive).
- Catastrophic bleeding: Look for severe bleeding that requires urgent attention.
- Airway: Check if the airway is open. Tilt the head back and lift the chin if there is no risk of spinal injury, as shown in the picture below. Clear obstructions and manage as needed.
- Breathing: Look for chest movement, listen for breath sounds near the mouth, and feel for airflow.
Checking airway method.
2 – Managing catastrophic bleeding
Catastrophic bleeding is life-threatening and can cause death within minutes. Immediate action is required to stop blood loss and stabilise the patient.
Pack and wrap. For deep cavity wounds use the pack and wrap technique:
- Apply direct pressure. Use a gloved hand to press firmly on the wound immediately.
- Pack the wound. Insert haemostatic gauze (e.g., Celox Rapid) deep into the cavity. If unavailable, use standard gauze.
- Hold firm pressure. Maintain steady compression for at least five minutes.
- Secure the dressing. Cover the wound and wrap a bandage to keep it in place.
- Check for ongoing bleeding. Reassess the wound regularly to ensure bleeding remains controlled.
Combat Application Tourniquet (CAT). If direct pressure is insufficient, apply a tourniquet to stop severe limb bleeding:
- Place the tourniquet 5-7 cm (2-3 inches) above the bleeding site, directly on the skin and above joints.
- Pull the strap tightly around the limb and secure it with the Velcro.
- Twist the windlass rod until the bleeding stops.
- Clip the Windlass rod into the Windlass clip to lock it in place.
- Check for bleeding control and distal pulse. If bleeding continues or a pulse remains, further tighten or apply a second CAT side-by-side.
- Time the application. Clearly mark the time. Tourniquets can cause tissue damage if left in place too long.
If a CAT is not available, improvise using a triangular bandage, scarf, and a stick to twist and apply pressure in the same manner.
Combat Application Tourniquet (CAT).
3 – Treating for shock
Physical shock can occur after severe bleeding or trauma. It reduces blood flow to vital organs and can be fatal.
- Lay the patient down. Rest them in a lying position to reduce strain if their injury allows them to be moved.
- Keep them warm. Use clothing or blankets to prevent hypothermia.
- Raise their legs. Elevate the lower limbs to improve circulation, unless injuries prevent this.
- Remember the rule: “If they are pale, raise their tail.”
This article is based on the content of a three-day HEAT training conducted by Silk Road Training and organised by Reporters Without Borders (RSF) in partnership with Exile Hub.
Silk Road Training offers online and in-person HEAT training led by expert trainers with over 20 years of training and security advisory experience globally to help media professionals and frontline journalists build life-saving skills in high-risk areas.
Exile Hub supports human rights defenders and media professionals facing persecution from the Myanmar junta, helping them continue their work safely through tailored assistance, safe housing, counselling, and skills training.
← Read Part 1: Preparing for civil unrest
← Read Part 2: Techniques to stay safe during civil unrest
← Read Part 3: Planning ahead in conflict zones
← Read Part 4: Responding to conflict threats in the field
