Street medicine has its origins in the civil rights movements in the US in the late 1960s. Over the years Street Medics have evolved into an international informal community of people who provide medical and first aid support at protests and direct actions. The Melbourne Street Medic Collective (formerly MelbFACT) came together through the Occupy movement in Melbourne. In the years that followed it carried out training, provided preventative care, treated injuries and responded to other physical and emotional needs.
Below are 5 articles from the Melbourne Street Medic Collective materials about basic safety, situation management, organisation and support.
- First Steps to take when an Incident Occurs
- Scene Management and Getting Help
- Operating Safely in a Crowd
- How to Document your Injuries Sustained at Protests
The information is intended to be used as reference material for educational purposes only and in no way substitutes or qualifies an individual to act as a street medic without first obtaining proper training led by a qualified instructor. To learn about specific medical and First Aid techniques it is suggested you undertake a certified and contact a Street Medics collective in your area.
1. First Steps to take when an Incident Occurs
This article provides tips in regards to the first steps Street Medics take when responding to a situation.
A Street Medic ticks off a number of very important thought processes before they even reach the casualty and give first-aid.
You are not a superhero and as such are not bullet proof, fire resistant and/or immune to the psychological impact of seeing blood and guts or a fellow human being suffering. In this phase, you get a grip on yourself, calm down with a few deep breaths and GROUND yourself. It might take a fraction of a section to compose your thoughts – or it might take longer – whatever works for you.
Survey the Situation
Having a good understanding of what is happening around you will better prepare you for what needs to be done. So before entering any situation in which you may have to give aid to a fellow protester ask yourself:
- Is it safe?
- Do you need to call emergency services?
- How many casualties are there?
- How many street medics do you need to help?
- What are the danger factors: (falling masonry, intoxicated individuals, rioting crowd, fire, police, chemical weapons or traffic)
Before you enter the scene make certain what happened to the casualty doesn’t happen to you. If you rush in to the scene unprepared you may find yourself adding to the casualty list.
Know your Limits
This is a key principle of Street Medicine so do not take charge of the situation if your mental/emotional processes are not up to it today or if you simply don’t have the skills. This is not about you and your ego. It is about the best outcome for the casualty.
Mechanism of Injury?
This is the moment when you get all Sherlock Holmes on the scene before you. Your initial impression counts:
- What is happening and how did it happen?
- Could there be a neck or spinal injury caused by that traffic cone you witnessed being lobbed into the crowd?
- There’s shards of glass everywhere and that blood is vividly red? Could it be arterial?
This swift initial assessment will help you make treatment decisions and inform the speed with which you have to make them.
Always approach a casualty from below or the side. You don’t want them turning their head if they have a neck injury and you sure as heck don’t want to suddenly appear in their field of vision giving them another fright! Also, NEVER step over or across a casualty.
The situation might deteriorate or become much more complicated than when you first arrived. The casualty might lose consciousness and you don’t know why?
Lots of people might be talking at once and you feel yourself becoming overwhelmed by all their voices and lost in new information. You might find your heart racing, you can’t focus or you’re grinding your teeth. Any, of these are good triggers to stop what you are doing and return to the beginning and reset to “D” again.
In fact, you can reset the DRSABCDE at anytime you feel you are losing control of the situation or might have missed something.
At training sessions first aid students always suggest that in the “D” stage they “look for fire”, “collapsing buildings” or “falling pianos”. Whilst, all these answers are technically correct, exposure to human bodily fluids is the most common danger any street medic will encounter – by far!
To protect yourself & your patient from blood borne diseases (such as Hepatitis B & C, HIV) it’s important to use plastic gloves. If you have no gloves a small plastic bag or cling-wrap will make do. Some people are allergic to latex (so try to get consent before touching).
Personal Protective Equipment (PPE) is all about protecting the first aider and the casualty. So, at the “D is for Danger stage” please make “Don’t get any on me” your mantra and don disposable gloves!
When confronted with an emergency don’t rush in all Leeroy Jenkins. Take a pause and deep breath as you assess the situation. This is the perfect moment to slowly draw on your plastic surgical gloves. This process grounds you and signals to others in the vicinity there is a calm, prepared person here ready to help.
Some good advice when wearing gloves:
- Put gloves on when approaching a casualty but don’t walk around with them on.
- Don’t wear gloves when not treating someone. It may send out confusing signals to the crowd who might panic!
- Do not accessorize! Disposable gloves are for one thing and one thing only: protecting you and your casualty. They are not a fashion statement.
- When assessing or treating multiple wounded people, change gloves and wash/cleanse your hands between each casualty. It would really suck if you transferred another person’s body goo into someone else’s wound! Also, chemical irritants like Pepper Spray are designed to spread through tactile contact so if you can’t keep calm and stay disciplined when decontaminating multiple victims of pepper spray find another way to help.
- Take gloves off when going through your kit. If you need to get something while caring for a casualty ask your medic buddy to get it.
- Dispose of soiled gloves sensibly and plan ahead. How will you dispose of contaminated gloves? You could be putting workers at risk by idly tossing chemical or blood covered kit into a public bin. You definitely are if you leave them in the gutter or verge. So, always carry a designated bag – ideally a medical waste bin – because a responsible street medic always safely dumps their own junk.
- Use alcohol gel to clean your hands between treating injuries (even if you wore gloves). It is the evaporation of alcohol gel that kills bacteria (so rub and allow to dry for at least 30 seconds). If your hands are visibly soiled use running water & soap to disinfect.
2. Scene Management and Getting Help
People attend protests because they want to make a difference. Most people want to help if an injury occurs in a large crowd. This aspect of human nature & community needs to be celebrated; but too many well-meaning protesters will only get in the way of assessing the injury and administering first aid (as well as potentially compromising the injured person’s right to confidentiality).
This article provides tips about how Street Medics can best respond to situations, call for help, and enlist the support of other protesters.
How Street Medics respond to situations
If an injury does occur Street Medics may:
- Ask for room so they can get to the casualty.
- Enlist bystanders to form a circle (facing outwards) to give the casualty privacy & so you can watch out for further hazards). This is called a Privacy Circle.
- Give other protesters roles (see below)
- Ask people to identify and designate someone with a mobile phone to standby in case we need to call emergency services.
First Aid is NOT about consensus. Street Medics will request your assistance firmly and politely – after all, there is a person who needs help and we don’t have time for another political meeting.
Calling for help
Time is critical in an emergency. This is never truer than when we get to “S” in DRSABDCE (Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillator, Extras). Heart muscle can die and irreversible brain damage can occur if medical assistance is not summoned in a timely fashion. If you find yourself in just such a woeful situation at a protest, then it is hoped you are working in a Buddy Team.
In a Buddy Team Street Medics have designated roles:
- Number One is the Patient Buddy
- Number Two is the Crowd Control or Comms buddy.
So, while the Patient Buddy is evaluating and stabilising the casualty it falls to the Comms Buddy to call in an ambulance. In so-called Australia medical assistance can be obtained from dialling 000 or 112 on mobile phones that have no credit or are locked.
Start by clearly stating that you need an ambulance. The Ambulance dispatch operator will ask some very specific questions and it falls to the Comms Buddy to answer these questions as clearly and factually as possible. They will ask:
- The location of the casualty including the city, street and points of access not blocked by crowds or police
- Your name and the number you are calling from – in case the calls is cut off or they need to contact the scene again later on
- A brief description of the situation
- Who is the casualty or casualties
- Are they conscious – answer simply yes or no
- Are they breathing – answer simply yes or no
The adrenaline will be running but try your best to make your answers clear and specific. Hang up AFTER the operator… this makes certain they have all the necessary information.
How other protesters can help
Help comes in many guises. Street Medics can channel the good will of fellow protesters in an emergency by allocating roles:
- RUNNER – A runner could dash off and pick up some supplies if you are running low (gauze, saline, hydration).
- ESCORT – An escort could be designated to go keep an eye out for an incoming ambulance and ensure it has safe egress to the scene.
- SCOUTS – Scouts could do overwatch and keep an eye out for hostile agents like fascists – or even riot cops – who will seek to disrupt a triage scene.
- PRIVACY CIRCLE – A crowd of people could easily be arranged into a PRIVACY CIRCLE to help protect the confidentiality of a compromised person from prying eyes and camera lenses.
- DRIVER – Some casualties have very good reasons not to want to engage with the hospital system and might simply need a DRIVER to transport them somewhere safe of their own choosing.
- VOLUNTEER – And what of that person flapping around the scene and getting in the way? Your initial instinct might be that they are a nuisance and they should just buzz-off – but check that thought and analyze the person and the situation. If there are not enough Street Medics to go around you could designate them to be a CALM VOLUNTEER to sit with someone who is experiencing anxiety or maybe send them off to find the casualties’ friend or lost property.
Remember: protesters are empathic people, whose natural instinct when seeing someone hurting or suffering is a desire to help. Street Medics redirect that energy all the time to help normalize a scene or bring calm to the streets.
3. Operating Safely in a Crowd
Here are a number of suggestions for operating safely in crowds including avoiding crushes, observing situations and bringing calm to them. It contains tips that will be useful for both Street Medics and protesters in general.
Large crowds can be deadly. Pushing, shoving, pepper spray, police horses and other perceived threats can create a ripple effect through a crowd resulting in mass panic as the crowd surges forward. Crush injuries through trampling are common but the most deadly is suffocation, with more people dying standing up than from trampling.
Keep in mind these risks and be prepared.
- Wear comfortable, closed toed shoes. Double tie your laces to prevent tripping.
- Avoid wearing dangly jewelry, scarves and neckties, as they may get tangled or pulled.
- Don’t go alone. Bring a buddy!
If things get risky:
- DON’T STAND STILL OR SIT DOWN! Keep moving in the direction of the crowd and slowly work your way diagonally across the crowd, toward the outside where the flow is weaker.
- Buy yourself as much personal space as you can by keeping your arms at your side, bending your elbows and pushing out.
- Don’t stop or stand near temporary structures, which could collapse under the weight of a crowd.
- If you drop something, don’t try to pick it up. Bending or getting your fingers stepped on or trapped will increase your risk of being pushed to the ground. Let it go and keep moving!
- If you fall or are pushed down, try to get back to your feet as quickly as possible. If someone is willing and able, extend an arm and ask for help getting back on your feet.
- If you can’t get up, keep moving! Crawl in the direction of the crowd until you can get back up.
- If you cannot get up at all, curl up in a ball to create an air pocket and cover your head. Keep your back facing up, protecting your head and face with your hands and arms.
- Crowds tend to surge or pulse. Wait until a lull in the pressure or flow to try to get back to your feet.
Buy yourself as much personal space as you can by keeping your arms at your side, bending your elbows and pushing out. People suffocate if they can’t expand their lungs.
Next time you’re inspecting a crowd for deteriorating activists consider your vantage point. Patrolling around the edges or standing amongst your comrades will only allow you to see a small portion of the crowd. Perhaps your time would be better invested in seeking some high ground from which to observe the surroundings.
A common opportunity is while a rally is passing or ascending stairs. You may also wish to perch above static gatherings. During large Occupy Melbourne general assemblies this proved to be a valuable method of spotting problems early and co-coordinating first-aid interventions for us.
When choosing your perch first consider your own safety. Swan diving from a traffic light onto a casualty is awesome but probably sub-optimally effective [randomised controlled trials not yet complete]. The danger of becoming an easy target for abuse from state or corporate agents must also be appreciated. Next consider the effort required to get to and from the perch; there’s no point spotting where you’re needed but not being able to get there in time. Finally make sure you won’t be leaving your post by perching; at some events you’ll be assigned a specific area to attend, make sure you can actually see it.
Being the Calm in the Crowd
One of the most important contributions Street Medics can make to a demonstration or a direct action is being The Calm in the Crowd. Here’s the Melbourne Street Medic Collective’s approach to remaining calm during an emergency and passing that sense of self-control onto other people.
In my experience confidence comes from three sources;
- Prior preparation
I recommend the first two sources.
2. Take a moment to ground yourself
Grounding helps you act with a level head & stay collected. Poor decisions and bad outcomes happen when you dash into a situation without preparing yourself. Grounding may only take a few seconds but is well worth performing as you approach a challenging scene.
Some Grounding techniques include:
- Slow your thoughts
- Take a breath: Exhale (imagine your breath sinking into the ground)
- Count to five
- OR say a prayer
- OR pull on protective gloves
- OR tie back your hair (whatever ritual works for you)
- And WALK to the scene … DON’T run.
It doesn’t matter what you choose to do to ground as long as it works for you and helps you remain calm and collected in the midst of confronting situations.
3. Acknowledge the pace and meet it
Every emergency has a pace you must meet. Experience, training and staying alert will help you identify it. Once you start looking you’ll discover that very few emergencies require split second decision making. Once you’ve identified the pace try not to exceed it and you’ll usually have all the breathing room you need.
4. Your best is all that is expected
Trust and respect are earned through consistency, openness, collaboration and commitment. Not infallibility.
5. You’re not alone….. unless you are
Don’t take on everything if you don’t have to.
6. Focus on the task at hand
Just concentrate on the one thing you’re currently doing. Whether it’s bandaging a wound, marshalling a crowd or planning your next steps.
7. Who’s emergency is it?
This may sound callous to some but, ask yourself “who’s emergency is this?” The answer is usually “not mine.” Then knuckle down and help the best you can.
8. Learn to acknowledge your feelings
Sounds simple but it’s a skill that takes practice to develop. Negative emotions tend to loose there grip on you once greeted.
9. Learn to acknowledge when the feelings of others are affecting you
Fear and anxiety are astonishingly contagious. However I find its grip is much looser once I’m aware it’s coming from outside.
4. How to Document your Injuries Sustained at Protests
The Melbourne Street Medic Collective believe the best way to avoid injuries is to Be Prepared and to look out for each other.
But, protest is struggle and unfortunately people will still get hurt by forces resistant to social justice and change. That is why being able to document injuries is an important skill for all activists, and especially so for groups who traditionally are singled out for acts of repression (such as people of colour, the homeless, transgender activists and even medics).
What follows are some tips on how to document these injuries.
At the protest
- Remember to seek medical advice as soon as possible!
- Keep all evidence (bag bloody clothes to put in the freezer when you get home, save projectiles etc)
- Talk to a Legal Observer who will record the time of the incident and may be able to talk to some of the witnesses
At the hospital or clinic
- If it is not a life-threatening injury consider visiting a GP or a clinic you trust
- Record the names of all treating doctors/ healthcare professionals who see your wound(s)
- If appropriate – tell hospital staff how you were hurt
- Wounds like broken ribs, concussion or torn ligaments don’t show up when photographed so ask the medical staff to write up all your injuries in detail
- Ask for a copy of your notes, x-ray, scans (you might not be allowed them but ask anyway)
- Take photos as soon as possible – severe injuries may heal quickly depending on your physical health and nutritional status
- Get a trusted friend to take a picture of your whole body before zooming in for detailed shots of the injured area
- Stand in front of an uncluttered, neutral coloured wall
- Take images from an assortment of angles and think about who might be scrutinizing these photos at a later date
- To get perspective take photos with a ruler or something of standard size (like a coin) next to the injury
- Use the ‘Date & Time’ tagging function on a digital camera or phone to show the injury changing over a period of time
- Darker skin may not show up injuries so take photos in a well lit place, and be careful with a flash as this may bleach out, or reflect off the skin and make the bruising look lighter than it actually is
- Keep a diary of the injury as it heals and how it effects your quality of life
- Remember bruises will darken and grow over time
- Store all your paperwork, images and evidence in a secure place
- Keep all follow-up care or Doctor appointments!
- Debrief frequently with your friends, loved ones or affinity group
Street medics are not a replacement for emergency services. They give care to protestors when needed but emphasize that PREPARATION is the key to any successful & safe action.
So before leaving the house to demonstrate for a Better World consider:
- Wearing clothes you can easily move in
- Covering your skin (long sleeves & pants for limbs & possibly a mask – or a simple scarf – for your mouth & nose)
- Wearing supportive & comfortable shoes you can run in
- Checking the weather forecast and bringing appropriate clothes to stay cool, warm or dry as required
- Tying back long hair (so it can’t be grabbed)
- Carrying some high-energy snacks
- Removing (or taping) jewellery (so it can’t be ripped off or snagged)
- Removing contact lenses (because chemicals can be trapped & cause eye damage)
- Bringing water (to hydrate and to irrigate eyes & wounds)
- Being ready to help out your fellow activists as needed
Be part of a buddy team
Where possible you should always attend a protest with 2 to 3 people you know and trust… stick with them all day.
Protesters have been using the Buddy System for decades now because:
- It’s safer (you’ve got each other back)
- You can share supplies
- You can assess each other’s mental & emotional state if things go haywire
- You can get a second opinion
- (Street Medics) One person can interact with the casualty whilst the other interacts with the crowd
- You know what medications your buddy is on & where they are stored
- You’ll be able to acknowledge your buddy’s warning signs, symptoms & triggers if things become stressful (useful in avoiding Critical Incident Stress developing into PTSD down the line)
- You’ll know what to do if one of you gets arrested
- You can debrief together afterwards
Being a Buddy means you never leave your partner(s) field of vision but, if you do get split up during the action be certain to have a back-up plan or meeting place in mind so you can hook up again later.
Consider the following situations:
- It’s late in the afternoon after a full day of actions in a week long campaign. People are starting to feel weary and sluggish under the baking hot sun and the exhaustion of thinking is only made worse by the sniping and grizzling everyone seems to be using against each other. The day’s almost at an end and all you want to do is sit down in the shade, take off your shoes and drink some water. Everyone else in the affinity group seems keen to get out of there as soon as possible and go to the pub, but you also want to raise with the group a concern about the action and you’re not sure that people want to listen.
- It’s 1 o’clock in the morning at an overnight encampment, cool air feeling like it’s freezing your damp clothing. The night has been fairly uneventful, save for a small but loud argument a few hours ago, and your body is nagging you to sleep. The next buddy team is due to come on shift and mind the first aid tent until the morning soon and you’re waiting for them to arrive.
- Today you have been taking part in a solidarity vigil against the forced deportation of a refugee from a detention centre. The vigil has progressed very smoothly, with no incidents and a good atmosphere amongst those who have attended. Yet, in listening to the speeches you couldn’t help but feel upset and a little disturbed by what you heard and it has started to make you feel quite stressed and anxious. On the outside, you seem okay – you don’t want to feel like you’re letting other people down. After all, you’ve been at these sorts of actions many times before without a problem, why start to worry now?
Each of the situations described above are not unusual ones to find yourself in when participating in protests. Long days and nights with little rest and even less sleep can grind even the most hardy down, while personal and political concerns can suddenly flare and become vitriolic. In order to deal with these issues and, if possible, prevent them from getting out of control we encourage affinity groups and even individuals to debrief after actions.
Debriefing is a process by which people come together after an incident or event to discuss what has happened and to come to a common understanding of what has just occurred. It is a useful opportunity to check in with other people and make others aware of how you are feeling, and to flag concerns or issues that arose during the incident.
Perhaps its primary use is being the first step in recognising and acting against Critical Incident Stress if there has been a traumatic incident. Through debriefing, questions such as “Did I/we do the right thing?”, “Is it okay to feel like this?”, “Should I/we have done more?” can be directly addressed and resolved, rather than leaving them to fester in the back of our minds.
It is important to keep in mind that trauma is subjective: different people may be affected by one situation in radically different ways depending on earlier traumas, coping techniques and a whole range of other factors. Hence the third example, above: in this case it is not seeing an act of violence, suffering or seeing a physical injury that has caused the trauma. Instead, repeated exposure to stories of severe suffering has taken its toll and the person in the example is experiencing emotional distress. You may also note that the example does not specify that the person is acting as a Street Medic: this process obviously has its benefits for medics (as the nature of our work at protests places us at a higher risk of encountering traumatic situations), but it is something that all protesters and affinity groups should consider and embrace. Trauma is by no means monopolised by Street Medics.
So, the advantages of debriefing amongst affinity groups are two-fold: to maintain and strengthen the affinity of the group, and to look out for the mental welfare of affinity group members.
How to debrief
Melbourne Street Medic Collective’s practice when it comes to debriefing is to debrief after every action, with an open invitation for non-medics to also attend. Sometimes this means debriefs are very short and quickly over and done with. Other times it has proved the opportunity for concerns to be aired, openly and without prejudice, and either quickly resolved or deferred upon agreement to a more convenient and appropriate time and setting.
We have also found it most effective to conduct debriefings as soon after the event/incident as possible and will generally move to a quiet area to debrief once the action has begun to wind up, so long as there are no immediate concerns/incidents to be dealt with.
Once assembled, someone volunteers to facilitate/chair the debrief and we conduct a check-in: taking it in turns to greet the group, describe how we’re feeling (“I’m all good”, “I feel like shit”, “I’m okay but I was pretty stressed for a while when the cops were getting aggro”, etc.) and briefly – i.e., one or two sentences – describe how we feel the action went.
For Street Medic collectives it is often useful to follow check-ins with any report-backs about incidents during the action (mostly because these may have been referenced during the check-in). Otherwise, a call is made for anyone to raise any concerns or points of praise for the action. This can be conducted in a similar manner to the check-in, with input from each person in the group, or input can be received through a general call-out to the group.
If a point is raised, it is important to remember that this process is intended to be constructive and that we need to be respectful of one another, even if the issue is of a personal nature.
Concerns should be raised without attacking a person, and responses called for after the first person has been given time to raise and explain their concern. Responses should be directed at the issue, not the person, and the discussion managed in such a way as to prevent digression or rambling. Here, active listening and non-violent communication skills are invaluable.
If needed, a two-minute time limit on speaking can be used and a speaker’s list employed to ensure the conversation is open to all and not dominated by a few key voices. Here, the role of the facilitator is key.
Discussion should be directed towards finding a resolution but, if this is not possible (after all, Rome wasn’t built in a day) within the current debriefing space, the group should aim towards setting another date and time in the near-future to further discuss and hopefully resolve the issue. If for some reason this cannot be arranged, emphasis should be put on trying to organise this as soon as possible in the following days.
1. After the action, find a quiet place away from the action
2. Nominate a facilitator
3. Conduct check-ins (How are you feeling/How do you think the action went?)
4. Make any report-backs
5. Ask group members if they have any issues they want to raise or any general comments on the action
6. If needed, agree on a date and time to follow up from the debrief
- Melbourne Street Medic Website Archive
- Street Medics – Keeping Our Movements Healthy and Safe
- Organising Your First Protest
- How to Organise a Protest March
- Legal Guides for Activists about Protests
- Make Change: How-To’s for Effective Peaceful Protest
- Blockades that changed Australia
- Direct action - Non violent NVDA
- Direct action - Violent
- First aid
- Protests_Rallies - Health aspects