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Dealing With Difficult Patients and Bystanders in First Aid Scenarios

Too often do we imagine that a real world first aid scenario is going to be hassle-free. In most cases, we can be met with difficult patients, bystanders or the environment in first aid situations. Difficult doesn’t always have to mean abusive or inappropriate. Sometimes difficult is only difficult because of language barriers, or comprehension issues. Sometimes difficult is due to the environment we’re in, such as a busy road or the edge of a pool. A crucial element to being a first responder is being able to analyse a situation and manage it accordingly. In any situation, we must remember that our own personal safety always comes first. With that in mind, here are a few tips on how you can manage a difficult situation.

Language Barriers

Language barriers present themselves in many different ways. At times the patient or bystanders may not understand English. They may be deaf and/or mute. They may be very young and unable to understand you or communicate effectively. In any of these cases, you will need to find new ways to get your message across. Translators, hand gestures, facial expressions, and writing or drawing are all methods you can utilise for this. For younger children, choosing age-appropriate language is crucial. If a guardian or parent is present, they may be able to help.


In many cases, first aid scenarios occur in undesirable locations. This can include busy roads, pool ledges, confined spaces, or heated environments. Employing a hierarchy of control can assist greatly in these situations. This may mean moving the patient from the scenario entirely, or standing back until more qualified help arrives. Remember, your safety is always the priority.

Distressed or Overwhelmed Family

In any given emergency, members of the family are likely to be overwhelmed, emotional, and possibly unpredictable. Finding ways to keep them calm and rational presents a problem for even the best first aiders at times, but to not do so could not only put yourself and the patient at risk, but the family. Appearing calm is the first step to ensuring those around you feel safe and cared for, even if you are panicked yourself. Before you approach any scene, take a deep breath. Look at the situation in front of you, but also around you. How are the bystanders behaving? How much room is available? Some bystanders may be willing to call 000 for you, or to wait at the side of the road for the ambulance. Family members are more likely to want to stay with their loved one, even if the scene is distressing. To prevent the scene escalating, try giving them smaller jobs to do that will give them a sense of purpose. They can hold the patient’s hand, or pass you items from the first aid kit. You could ask them to write down patient details, or get them to reassure the patient. Whatever you do, it is important to speak to them respectfully but firmly. Ensure they understand what you are doing and why, as this will help put their mind at ease. If at any point a bystander begins to act dangerously, remember that your safety must come first. Back away, and call 000 if necessary.

Intoxication and Altered Conscious States

Often we associate slurred speech and stumbled walking with drugs and alcohol, however this is not always the case. Many medical emergencies, such as diabetes and strokes, present with similar symptoms. No matter the cause, this can make it very difficult to give adequate care and treatment to the patient. In these situations, be sure to use simple, clear, and concise language. Ask them if they understand, and get them to repeat back to you if necessary. Be careful not to come across as condescending; instead, show compassion and concern. Keep all comm unication friendly and open. Avoid lying or stretching truths, as this will damage any trust you have built.

Every first aid situation is different, but learning how to diffuse tension and calm down those around you will ensure a much smoother process. Clear, honest, age appropriate communication is paramount. And remember; if you are ever concerned for your own safety, back off, re-assess, and respond accordingly.

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