“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 sixth article outlines how to manage airway emergencies, respond to choking, treat chest injuries, and perform resuscitation in hostile 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 working in conflict zones must be prepared to manage life-threatening injuries when professional medical help is delayed. After controlling catastrophic bleeding, ensuring a patient can breathe is the next priority.
1 – Airway and breathing
A blocked airway is a common cause of preventable death. If the patient is unconscious or injured, ensuring oxygen can enter the body is critical.
- Check the mouth. Remove visible obstructions to let the air pass.
- Open the airway. Turn the patient onto their side. If no spinal injury is suspected, use a head tilt and chin lift.
- Assess breathing. Look for chest movement, listen and feel for breathing by their mouth. Continually check breathing throughout treatment.
2 – Choking
If the patient is awake but unable to speak or cough effectively, they may have a severe airway obstruction. Immediate action is required.
- Encourage coughing. Support the patient and prompt them to clear the obstruction themselves.
- Give back blows. Lean them forward, support their chest, and deliver five firm blows between the shoulder blades.
- Perform abdominal thrusts (Heimlich Maneuver). Stand behind, grasp your fist above the patient’s navel, and pull sharply inwards and upwards.
- Alternate techniques. Repeat five back blows and five abdominal thrusts until successful or the patient becomes unresponsive.
3 – Penetrating chest injury
A penetrating chest wound—such as a gunshot—can create a “sucking chest wound,” where air enters the chest cavity and collapses the lung. This is a life-threatening emergency.
- Seal the wound. Immediately cover the wound with your hand, plastic, or another airtight material to prevent further air entry. If available, apply a vented chest seal.
- Reposition carefully. Ensure the airway remains open. Keep the patient sitting upright if possible to aid breathing.
- Control bleeding. Apply firm pressure around the wound using sterile gauze, a clean cloth, or part of a trauma dressing.
4 – Resuscitation (CPR and AED)
Cardiac arrest can occur due to trauma, shock, or obstruction. Immediate resuscitation offers the best chance of survival.
- Check airway and breathing for up to 10 seconds.
- Call for help (112 in many countries) if breathing is absent or abnormal.
- Start cardiopulmonary resuscitation (CPR). Give 30 chest compressions in the centre of the chest followed by 2 rescue breaths (blowing into the victim’s mouth while pinching their nose).
- Use an automated external defibrillator (AED). Follow the machine’s voice prompts, apply pads to the bare chest, and deliver shocks as instructed.
- Continue CPR cycles until signs of life return or professional help arrives. If possible, swap out with another person when you become exhausted.
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
← Read Part 5: First Aid – Assessing casualties, managing catastrophic bleedings
