What to do in the ten minutes before the ambulance arrives

An ambulance takes minutes to reach you. Sometimes more. Whatever happens in those minutes is down to whoever's standing there, and that's usually not a professional. It's a husband, a coach, a bloke at the next table.

The good news is that the things which save lives early are simple, physical and learnable in an afternoon. The order matters more than the technique. Get the order right and you'll do most of the job even if your hands are shaking.

Read this, then go and book a course with a recognized provider — St John, the Red Cross, a local ambulance service. Reading about chest compressions and doing them on a manikin are different skills. This is the map, not the training.

Before you touch anybody, look up

The first casualty of an emergency is often the person who ran in to help.

Stop at the edge of the scene and spend three seconds on it. Moving traffic. Live wires. Gas. Water. Fire. Someone who's still swinging. A ladder that came down and might come down again.

If the scene isn't safe, you don't go in. You control what you can from where you're — turn the power off at the consumer unit, stop traffic, get people back. A second casualty doesn't help the first one.

Gloves if you have them. If you don't, a plastic bag over each hand works.

Call early, and put it on speaker

People wait far too long to call, usually because they're hoping it resolves itself.

Call as soon as you know something's wrong. Give the address first, before anything else — if the line drops, they can still send help. Then say what's happened in one sentence.

Put the phone on speaker and set it down. The call handler will talk you through what to do next and they're very good at it. They'll count compressions with you. They'll tell you where the nearest defibrillator is and the code to get it out of the cabinet. Don't hang up because you feel busy.

If there are other people around, point at one and give them a job by name or by description. "You, in the blue coat, go to the main road and wave the ambulance in." Crowds do nothing when instructions go to everyone.

Catastrophic bleeding beats everything

If blood is pumping, spurting, or pooling fast, that's the first thing you deal with — before airway, before anything. Someone can bleed out from a limb in a few minutes.

Press. Hard, directly on the wound, with the heel of your hand and your body weight over it. Not a gentle dab through a tissue. Push like you mean it and hold.

Don't keep lifting to check. Every look restarts the clock on the clot.

If it's a deep wound and you've got dressings, pack them firmly into the wound cavity and keep pressing on top. If it's an arm or leg and pressure isn't holding it, a tourniquet goes high on the limb, above the wound, tightened until the bleeding stops — which will hurt, and that's expected. Note the time it went on and tell the crew. Once it's on, it stays on until a clinician takes it off.

Are they awake, and are they breathing

With the big bleeding controlled, check responsiveness. Shout and shake the shoulders. "Can you hear me?"

If they respond, they have an airway and they're breathing. Talk to them, keep them still, find out what happened.

If they don't respond, open the airway. One hand on the forehead, two fingertips under the bony part of the chin, tilt the head back. Now put your cheek near their mouth and look along the chest for up to ten seconds.

You're looking for normal breathing. Not a gasp every fifteen seconds. Agonal breathing — irregular, noisy, fish-like gulps — happens early in cardiac arrest and it fools people constantly. If you're unsure whether it's normal, treat it as not normal.

If they're not breathing normally, start compressions

Heel of one hand in the center of the chest, other hand on top, fingers interlocked. Arms straight, shoulders directly over your hands. Push down about 5 to 6 centimetres — a good two inches — and let the chest come all the way back up between each one.

Rate is 100 to 120 a minute. Faster than feels natural. Most people do it too slowly and too softly.

Ribs sometimes crack. Keep going. A cracked rib on a living person is a fixable problem.

Send someone for a defibrillator while you work. When it arrives, turn it on and do exactly what the voice says. Pads go on bare, dry skin. Nobody touches the patient while it analyses or shocks. It won't shock a heart that doesn't need it — you can't hurt someone by attaching one.

If there are two of you, swap every couple of minutes. You'll fade faster than you expect, and tired compressions get shallow without you noticing.

If they're breathing but out cold

Roll them onto their side, head tilted back slightly, so the airway stays open and vomit drains out rather than in.

Then stay there. Watch the breathing. If it stops or changes, you're back to compressions.

The handful of others worth knowing cold

Choking. If they can cough, let them cough. If they can't make a sound, five sharp back blows between the shoulder blades with the heel of your hand, then five abdominal thrusts, alternating. Babies are different — back blows and chest thrusts, never abdominal — and that's a reason on its own to do a paediatric course if you've got small children.

Stroke. Face drooping, arm drift, slurred speech. Note the time they were last definitely normal, because treatment options depend on it. Nothing to eat or drink.

Seizure. Don't restrain them, don't put anything in their mouth. Move the furniture, cushion the head, time it. When it stops, recovery position. Call if it runs past five minutes, if it's their first, or if they don't come round properly.

Burns. Cool running water for twenty minutes. Actually twenty. Get rings and watches off early before swelling starts. No ice, no creams, no butter. Cling film laid on loosely afterwards.

Suspected spinal injury. If they're breathing and safe where they're, leave them there and support the head in the position you found it.

The handover

When the crew arrives, they want thirty seconds, not a story. What happened, what time, what you did, and anything you know about medications and allergies. If you can, put their medication boxes in a bag and hand it over.

Then get out of the way and let them work.

What goes wrong

Hesitating. Compressions too shallow. Long pauses in compressions while everyone discusses things. Nobody actually calling because everyone assumed someone else had. Peeking at a bleed. Moving someone who didn't need moving.

All of that comes from not having done it before, which is the one thing you can fix in advance.

Most of the emergencies you'll ever attend happen in your own house, to people whose names you know. Book the course this month, and get your wife and your teenagers on it with you.