Trained in First Aid

I was at a conference recently and, much to my embarrassment, I got a rather bad paper cut. As luck would have it, the woman sitting to my right said she was an ER nurse and she offered to help. But then a young woman on my left said she had just finished an intensive five-week course to become Trained in First Aid. With a mixture of innocence and confidence, she asked me, "Could I test out my new skills?"

I appreciated the young woman's eagerness so I accepted her offer. She set about mending my finger with a few first aid supplies she kept in her bag.

As she mended my finger she described the process: "Apply pressure with sterile gauze to stop the bleeding, clean the wound, apply an antibiotic, then bandage neatly and securely to ward off potential infection." Her process looked like what I pictured other healthcare professionals doing in that situation, so I was happy.

"Is that how they taught you in the first aid class?" I asked.

"Yes, we practiced how to stop bleeding and fix cuts many times. I learned how to fix all kinds of things," she replied confidently.

I looked to the nurse for her approval. "Is that how you learned to fix paper cuts?" I asked, hoping my tone didn't come across as too condescending. Her reply began with a "Yes" but continued in detail about the benefits and potential problems with different kinds of antibiotics, how to determine when cuts need stitches, and then she started using some medical terms I didn't know. My mind wandered in the jargon, thinking she misunderstood my reference to a simple paper cut. I asked again, "But my paper cut...what this nice girl did should fix it, right? Can I consider myself healthy?"

That unfortunately struck a nerve with the nurse: "Being healthy is not a matter of 'fixing' things. I didn't spend four years getting a nursing degree and many more hours in professional training to learn how to 'fix' things. The notion of being 'healthy' is a very big idea, and there's no such thing as 'perfect health.' I'm just one part in large system dedicated to people's health care needs, and helping patients help themselves is more important than anything I could pretend to 'fix'."

The nurse's tone made me uncomfortable so I turned back to the eager young woman, now neatly putting away her first aid kit. "How do you see yourself as a healthcare worker?"

"I guess I haven't thought about it that much. I just want to help people when they're sick or hurt," she sweetly replied.

"Have you thought about being a nurse or doctor someday? I really liked your bedside manner," I said.

"No, not really. I just took the first aid class so I could work at a summer camp for disadvantaged kids. I've always liked working with kids, and the experience will look good on my resume when I apply to graduate school."

"Medical school?" I pressed.

"Probably not," she said. "My dad is a doctor, but I'm really hoping to pursue business or law."

What a shame, I thought to myself. We'd be better off as a society if eager young people trained in first aid were always there to help, especially for those people without much access to health care. For many people, I thought, a young man or woman like this could help with many things we typically leave up to nurses and doctors who require longer and more expensive training.

The session ended and we filed towards the exit of the conference center. Just as we approached the doors I heard a loud explosion from across the street. I was stunned and confused and saw both the nurse and the young woman running outside to help. Through the smoke and debris on the street, I saw a few dozen injured people making their way out of a restaurant. The young woman rushed to one of the first ones out, a man with a cut on his arm. First aid kit in hand, she began the same practiced procedure she used with me to clean and cover the injured man's wound.

I looked for the nurse, but she hadn't stopped at the first few people she saw. Instead, she was busy putting people in groups: she directed people with cuts to gather together in the street, while those too injured to walk were carried down the sidewalk to relative safety. There was a small group of people nearby who appeared to have suffered burns, and the nurse was attending most closely to three people who were having trouble breathing. She spotted a man carrying a first aid kit and I heard her yell, "Take that over there," pointing to the group with cuts. "Get some people to help you apply pressure to the wounds." I joined the man in helping people tend to their lacerations, following the same steps the young woman had just used minutes before when helping me with my paper cut.

Sirens from multiple directions got louder and as the EMTs arrived both the young woman and the nurse described the situation. I heard the young woman talk about people who were bleeding while EMTs pressed her for more detailed information. The nurse, on the other hand, was able to give very short, specific directions to the EMTs using medical terminology I didn't understand. When she had used that jargon with me I had been unimpressed, but in this context it took on urgently needed usefulness and carried a mark of professionalism.

As the injured were treated and rushed away to a nearby hospital, I thought about the eager young woman Trained in First Aid. I don't think I had misjudged her — she did what she had been trained to do and provided valuable help. With more training and experience, I saw no reason she wouldn't be able to triage victims and respond with the level of professionalism I'd seen from the ER nurse. What I had misjudged, however, were the demands of people needing help. Had I been in that restaurant, I probably would have suffered far worse than a paper cut.

Accidents can happen anywhere. People need quality health care everywhere. For the eager young woman to be part of a long-term solution, she'd need to commit to far more than five weeks of first aid training and a summer at camp. But that wasn't her plan. To me, that means she and others like her are unlikely to be part of a solution. That doesn't mean she's part of the problem, but there is a problem when we fail to believe and invest in well-trained, experienced nurses and doctors. The ER nurse was right: health care needs come both big and small, and it's not about providing a 'fix.' Health is a process, and health care needs to be a system to support that process. Needs run deeper than paper cuts, and we can't expect to meet them all with eager young people Trained in First Aid.

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