• INTRODUCTION

Foreword : You may have realized that some of these materials were re-used from my past year's publication because the introduction is about the same. 

My name is Aaron, I'm a final year nursing student at the Institute of Technical Education here in Singapore. I've worked part-time in event companies and organizations to provide first aid coverage. I'm also part of the *National Disaster Response Team, having received basic training and medical specialization. This is my second time participating in the #Ambulance course and it's a privilege to be able to interact with members from the healthcare scene and volunteers  around the world such as yourself!

 In Singapore, there is minimal to no violence. However, external and internal threats such as radicalism and terrorism have surfaced over the past few years, with the most recent one being the arrest of a childcare teacher for turning over to ISIS. 

That being said, I'm part of a team of volunteers. We do first aid coverage on a volunteer basis usually during weekends and public holidays with the exception of some national events depending on the deployment dates provided by the community resilience department in Singapore Red Cross .

We're equipped with access to ambulances or an equivalent should we require the evacuation of a casualty. Our standard attire includes our organization's shirt and long pants with covered shoes.Out in the field, we have radios to keep in touch with one another ( However, in certain places such as Pulau Ubin, they're unreliable so we fall back on our phones to keep in touch ) We do have a team of people monitoring the security situation in Singapore, but I have not had the opportunity to intimately work with them. Given the opportunity, I would like to look into utilizing the incident command system at these events.

*National Disaster Response Team (NDRT) is a training programme that prepares volunteers for deployment in response to local incidents and overseas missions. Roles include responders who are trained in first aid, healthcare, psychosocial support (PSP), restoring family links (RFL) and operations

• THE SECURITY RISK

As per what I've mentioned above, terrorism is the main security risk to not just us healthcare workers, but to all our citizens as well. This includes members from the service line. Bomb threats can impede access to areas where a mass casualty situation may arise. 

Terrorism is the unlawful use of violence and intimidation, especially against civilians, in the pursuit of political aims.

Over the past years there have been a number of false alarms and the authorities here have re-iterated to us how we should not take the situation lightly. The very fact that this threat may well already be on our shores not only generates fear, but calls upon the need to be prepared. (This will be further elaborated in part 2 and 3) Here are some articles that will hopefully give you a better understanding of the local context.

https://www.mha.gov.sg/newsroom/press-releases/Pages/Singapore-Terrorism-Threat-Assessment-Report-2017.aspx

http://www.todayonline.com/singapore/greater-terrorism-risk-asia-amid-rise-isis-presence-report

http://www.straitstimes.com/singapore/first-woman-held-under-isa-for-pro-isis-activities

http://www.todayonline.com/singapore/man-arrested-security-scare-hougang-mrt-station-out-police-bail

 

Terrorism is about the worst security threat we can have on our densely populated island. It can come in many forms, be it bomb threats/incidences, chemical attacks as well as shootings (some of which have unfortunately occured in the past decade) Therefore appropriate preparatory responses have been formulated. 

Some of these responses include getting trained in Psychological First Aid, as well as understanding the different emergency protocols and how we as volunteers can help should a crisis arise. 

In the past two years I've done these and I would like to share some of the key take-aways from these courses. 

• Psychological First Aid

A new course that was only available last year and adapted from the Danish Red Cross, it focuses on gearing volunteers with the skills and knowldge to be a provider for psychological support in times of crisis. We went through simulations and tasks by a trained psychologist. This gave us a better understanding from the perspective of a casualty, which enhances our ability to be able to meet their needs at that given point in time. We also touched on how to conduct ourselves and behave around these people in need (i.e. not addressing them as casualties directly on the ground )

• National Disaster Response

This course taught volunteers about the various local government agency's guidelines, policies and protocols in times of crisis and what part we played as members of the Red Cross organization ( we focus on treatment of P3 casualties ; with references to the triage system that many of us are familiar with ).

• Disaster Site Medical Command

This course re-inforced aspects of National Disaster Response and added in the triage sort and ways we as volunteers can assist the healthcare workers.

(Note that these resources were obtained from the Disaster Site Medical Command(DSMC) course. )

One local solution to prepare for the security risk (terrorism) would be to be first equipped with the skills and knowledge on how to approach the situation or when the situation approaches you. Another solution would be to always be ready and geared up should a crisis arise. These solutions are useful in times of crisis because it gives us the ability to meet not only our own needs, but the needs of others as well. 

• How it works

Skills and knowledge + Tools = Operational Readiness

In light of the subject that we're introducing to our youths in the Singapore Red Cross (Disaster Management), we have a kit called the "GO bag". It's basically a bag that's equipped with items and equipment that would meet a person's needs for up to 24 hours post-crisis. Some of the items included are radios, water, batteries , personal identification etc. Go bag loadouts differ from country to country to meet the different types of crisis and their respective needs.

• Who can or should adopt this practice?

Volunteers and members of the public can and should adopt this practice as it would mean that more people are self-sustainable in times of a crisis. 

• Is this practice standard operating procedure in your organization? 

While there is no written rule that states that it is mandatory, many of us volunteers here in the National Disaster Response scene do have a practice of gearing up both in skills and knowledge as well as tools in order to respond to a crisis. 

• Context: Do you think this practice could be useful in a different context (community, country, political climate, etc.)? 

I do believe in other communities, countries and different climates, the same practice can be done. As information is made more and more readily accessible through platforms such as this #Ambulance course, we can gear ourselves up to better respond to a crisis or situation that would require our intervention. In fact, countries such as America have already adopted such practices for a long time. I have had the privilege to personally see what some of my international friends have come up with and some of which include a firearm in their kit for personal protection! ( Not applicable in my local context and I understand that as healthcare workers we should not bear arms ; which is why I found it so fascinating )

• Change process: What is (or was) required for this practice to be adopted?

I believe all it takes or rather, took, for this practice to be adopted was a moment of inspiration and the spur to want to share this knowledge with the people serving alongside us. We ourselves as volunteers should also have the hunger to want to be prepared. This will aid in building a positive learning mindset. In all technicalities, it was a vision set by our director for youth services and executed by volunteers under his wing. 

• Risks and limitations: What are the challenges in adopting this practice for you, your team, and your organization? What are the potential problems or limitations of the practice?

So far the challenges that I've come across or have come to know about are financial limitations. As many courses and equipment require substantial amounts of funds, not all volunteers can afford to be as readily equipped as others. Another challenge would be the willingness to take the first step. Driven by fear/anxiety it's unfortunate that many volunteers turn away from opportunities to be prepared as the very thought of being directly involved in a crisis is intimidating to most. 

That being said, I believe the organizing committee for these initiatives are working to find ways to engage more people in order to build on our pool of responders should the given security risk (terrorism) arise. 

Though it is not mandatory to add in this section, I would like to make it a good practice to include some questions I have gathered from the reviews recevied. Therefore this segment will serve as a compilation of my responses to these questions. (Some portions of the questions have been omitted for the sake of confidentiality.)

 

Q1.As Singapore is a very densely populated area, would this make the security threat and the casualties more difficult to manage?

• Definitely. High population density means a higher body count and also means more people being directly affected by the event that takes place. I would not see this as a security threat unless it is in the context that terrorist members who may or may not be acting alone choose to take refuge in the dense crowd of people to escape or cause further harm to more people or even myself. In terms of management it would be far more difficult to meet the needs of so many people at once and this is what would make casualties more difficult to manage. It is estimated that even hospitals will have difficulties dealing with the sudden influx of people who require medical attention.

 

Q2.Would this (Psychological First Aid) be used at the time of an attack, or after the attack is over in order to help people psychologically?

• Having attended the Psychological First Aid provider course, the focal point would be on post-disaster mitigation. While the course teaches us hard skills such as how to manage casualties and what to do based on their response ( sometimes requires escalation to Institute of Mental Health staff). On top of that, they teach us how to identitfy the characteristics of casualties who are more prone to fall into psychological distress i.e. being excessively quiet. The way the course is structured is such that we understand the how various scenarios / disasters play out and what will the response be like from the members of the public during times of distress. Knowing the mechanism of an event helps us be prepare before the situation plays out as it allows us to create pre-emptive measures such as preparing our gear and ourselves, mentally.

 

Q3.This practice of having a go bag is different for me personally, as we don't commonly have something like this. Would the go bag contain more medical equipment or only things for personal survival?

• To answer your question we have to first look at the objectives of having a GO bag. The objective in the GO bag is to render aid and supplies to yourself to keep yourself sustainable for the next 24hours after a disaster/incident. Should you have the wellbeing of loved ones in mind, it is the norm to prepare supplies for them as well. Secondary would be the wellbeing of the people around you. If you are able to carry medical equipment and utilize them to the benefit of others, it can also be done. However, as a default there should be enough supplies to last you for 24 hours ( this is being taught to students in Disaster Management under the Singapore Red Cross Youth at the moment ) Therefore anything additional is allowed if its within your capability and skillsets/qualifications. For the general public, a GO bag would typically contain more things for personal survival than medical equipment.