Responding in an Emergency: Should You Be a Bystander or Act?

Here's what you can do in a few common emergencies

Woman calling emergency services at car accident
Immediate responders start helping before First Responders even know there's a problem.. Caiaimage/Robert Daly / Getty Images

Bystander is a word we use in emergency services to mean an innocent person who is in the proximity of an incident. It can be someone who sees a car accident, a heart attack, or a fight. It can be people on the sidelines of the Boston Marathon or dancing on the floor of the Pulse Nightclub in Orlando.  No matter where or what kind of incident it is, paramedics and police officers tend to always use the term "bystander."

But bystander is a passive word. It means what it says; that the person is standing by—simply near what is happening. A bystander doesn't help. He watches. A bystander isn't useful. She just gets in the way.

The thing is: most people don't really act that way. They jump in and help when the going gets tough. A witness comes forward and tells the authorities what he saw. A Good Samaritan pulls the injured to safety or tries to stop the bleeding. Whatever needs to be done usually gets done by the person on the street or the patient's coworkers. Most people don't just stand by.

Immediate Responders

The media is very familiar with the idea of First Responders. These are the folks who come to our aid when we need help. Most of the time, the term refers to firefighters, police officers, emergency medical technicians, and paramedics. As great as it is to be recognized as the people who lead the charge to help those in need, the reality is that First Responders often aren't first.

Before the First Responders, there's the immediate responder. It's the person, usually without training, who steps in to do whatever he or she can to stop the bad things from happening and start doing the good things. The immediate responder is already helping before the first responders have been notified of a problem.

It's the immediate responder (what I've called in other articles a lay rescuer or, in some cases, a bystander) who is doing chest compressions when paramedics walk through the door.

The immediate responder is the one who called 911 in the first place.

If you're reading this, you want to be an immediate responder. I'm not suggesting you want something bad to happen. I'm just saying you want to be prepared. You want to know what to do in the event of a medical emergency or an active shooter situation. You are the type of person who won't stand by and watch without jumping in to help.


The best immediate responders are those with at least a little training, whether in the classroom or with information that is self-taught. Knowing what to do in an emergency gives you a leg up—even if it's only through instruction rather than by getting first-hand experience. With training and information, you will be more likely to act in a way that provides real help. So, get trained. Take a first aid course.

Learn CPR. Watch the Run, Hide, Fight video. Inform yourself.

What You can Do

You might be thinking you need more supplies and equipment to be truly ready. But being prepared doesn't mean you have to have gear. There is plenty you can do in an emergency without a first aid kit or a paramedic license. In fact, Murphy's Law says you won't have any of that fancy gear when the stuff hits the fan.

Most of the supplies in a basic first aid kit are for minor injuries of the type that aren't going to kill you. Bandages and ointments do not save lives; actions do.

Emergency #1: Cardiac Arrest

Depending on the type of emergency, there's a lot you can do to provide care or assistance. In the case of cardiac arrest, CPR is the most important step and it doesn't matter how well educated you are. Paramedics or doctors are going to do the same basic CPR that a lay rescuer (or immediate responder) would do for a patient with cardiac arrest. They're going to focus on the same thing you should be focused on —chest compressions.

Chest compressions are the single most important skill in cardiac arrest, and since cardiac arrest leads to certain death if not treated, chest compressions could be the single most important skill in medicine. If you do nothing else for a person who is not breathing, call 911 and push on his or her chest. Keep pushing until help arrives and tells you to stop. That's right: even once the paramedics walk in the door, don't stop until they say so (usually not until they're ready to take over for you).

Emergency #2: Choking

The Heimlich maneuver (abdominal thrusts to clear the airway of a person who is choking) ranks right next to chest compressions in the it-can't-wait category. When a piece of steak (or hot dog, hard candy, cuff link, gumball, etc.) is stuck in the windpipe, it will kill a person in just a few minutes. By the time First Responders get to the scene, the patient will likely be dead...

...unless you help. 

Like chest compressions, you don't need any sort of equipment to do the Heimlich. All you need is to act. Wrap your hands around the person who is choking and squeeze the steak right out of him. Keep trying until he coughs it up or passes out. If he does pass out, call 911 and push on his chest just like for cardiac arrest.

Emergency #3: Bleeding

Bystander CPR (there's that word again) has been at the forefront of public education since the turn of the 21st century. Since 2015, bleeding control has been added to that message. Authorities realized how dangerous hemorrhage can be in the civilian setting after studying several mass shootings. Medical training initially intended for soldiers to use during combat are now constantly being studied and adapted for civilian use.

While the impetus for change started with active shooter situations and terrorist attacks, there are lots of other causes of bleeding that the average person is much more likely to encounter than combat. Regardless of the cause, hemorrhage has to be stopped quickly or the person could die.

Pressure on the wound is the best way to stop bleeding. Technically, you don't need anything but your hands to provide the pressure, but a clean cloth is helpful. Holding something against the wound to help the blood collect and coagulate will help control the bleeding. Holding pressure is often not comfortable for the patient or for the rescuer. It may take quite a bit of pressure to stop blood flow, even from a modest injury.

Just like for chest compressions above, don't let up on the pressure until help arrives and tells you to do so.


Tourniquets as a treatment for hemorrhage have had a rocky relationship with civilian EMS. At first, tourniquets were the go-to bleeding control device. Then, they were denigrated as potentially causing severe tissue damage bad enough to lead to loss of limbs. Circa 2005, tourniquets got a second chance.

The problem with tourniquets is that they are the exceptions to the no-gear-necessary rule. To properly use a tourniquet, you need a proper tourniquet. Improvised devices fail 100% of the time. If your tourniquet doesn't include a windlass (some sort of handle to twist it very, very tightly) it won't work. Worse, in one study only a pair of chopsticks survived life as a windlass without breaking. Don't even bother with a tourniquet if you don't have a commercial version and the training to apply it; use pressure to stop bleeding and remember to just push harder if the bleeding doesn't stop.

Do Something

Ultimately, the most important thing to remember is not to be a bystander. Respond immediately in the face of an emergency. Call 911 for help and follow the instructions of the dispatcher.

When all else fails, talk to the person in the midst of a medical emergency. If all you do is pet her hair or hold his hand, it is something. Nobody wants to suffer alone.


(2016).Active Shooter Pocket Retrieved 31 July 2016.

(2016).Tactical Emergency Casualty Care (TECC) Guidelines. Retrieved 31 July 2016.

King DR, Larentzakis A, Ramly. EP; Boston Trauma Collaborative. Tourniquet use at the Boston Marathon bombing: Lost in translation. J Trauma Acute Care Surg. 2015 Mar;78(3):594-9. doi: 10.1097/TA.0000000000000561.

Kragh JF Jr, Wallum TE, Aden JK 3rd, Dubick MA, Baer DG. Which Improvised Tourniquet Windlasses Work Well and Which Ones Won't? Wilderness Environ Med. 2015 Sep;26(3):401-5. doi: 10.1016/j.wem.2014.12.028. Epub 2015 Mar 12.

Neumar, R., Shuster, M., Callaway, C., Gent, L., Atkins, D., Bhanji, F. et al. (2015). Part 1: Executive Summary. Circulation 132(18 suppl 2), S315-S367. doi:10.1161/cir.0000000000000252

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