“Hostile Environment Awareness Training (HEAT) for journalists” is a ten-part series developed by Reporters Without Borders (RSF), Silk Road Training and a local partner. This seventh article outlines how to perform first aid secondary assessments, manage hidden injuries, monitor a patient’s condition, and report clearly to emergency responders.
Hostile Environment Awareness Training (HEAT) is a comprehensive safety training course covering core areas of preparedness for journalists working in high-risk environments. It includes preparedness for civil unrest, conflict zones, hostile environment first aid, vehicle safety, and digital security. Journalists need to watch for changes in condition after urgent bleeding and airway issues have been addressed. Secondary injuries not obvious at first glance should also be seen to.
1 – Secondary assessments and injury management
A full-body check allows you to catch injuries that were not initially visible. Some wounds—especially internal bleeding, fractures, or burns under clothing—may not be obvious. This check is essential, especially if the patient has been moved or is unconscious.
- Check from head to toe. Look, listen, and feel for injuries beneath clothing.
- Cut away clothing. Use trauma shears (scissors) to expose wounds fully.
- Monitor vital signs. Continually check for changes in pulse or breathing.
- Head and neck injuries: maintain alignment, stop bleeding, and stabilise with hands.
- Open abdominal wounds: do not reposition organs. Cover with a damp dressing or plastic and secure loosely.
- Broken bones: stop external bleeding, support injured limbs, and splint if evacuation is delayed.
- Burns: cool with water for 10-20 minutes, remove constrictive items, apply light dressings, and monitor for shock.
2 – Monitoring vital signs
Monitoring helps you track whether the patient’s condition is improving or deteriorating. Certain changes can indicate shock, internal bleeding, or infection.
- Complexion: Observe colour, temperature, and moisture. Pale, cold, or sweaty skin may indicate shock or medical distress.
- Heart rate: A normal adult heart rate is 60–80 beats per minute. Count heartbeats for 15 seconds and multiply by four.
- Breathing rate: A normal rate is 12–20 breaths per minute. Anything below or above could indicate distress.
- Capillary refill: Press a fingernail or patch of skin until it blanches, then release and observe how quickly colour returns. Normal refill time is under 2 seconds. Delayed return may indicate shock.
- Monitor dressings and splints. Ensure continued effectiveness and adequate blood circulation.
- Keep the patient warm. Use blankets, coats, or clothing to maintain body temperature and prevent hypothermia.
3 – Reporting casualties
Accurate and concise casualty reports help emergency teams respond quickly and efficiently. In chaotic or noisy settings, clarity saves time—and lives. Repeat location if needed. Do not assume it was heard the first time. Communicate to them:
- Location: use GPS tools or apps such as what3words to share your exact position.
- Incident details: what happened, any ongoing risks.
- Other services involved: who else was on scene.
- Number of injured: single or multiple.
- Extent of injuries: major bleeds, unconscious, breathing status.
This article is based on the content of a three-day HEAT training conducted by Silk Road Training and organised by Reporters Without Borders (RSF) and a local partner.
Silk Road Training offers online and in-person HEAT training led by expert trainers with over 20 years of training and security advisory experience globally to help media professionals and frontline journalists build life-saving skills in high-risk areas.
← Read Part 1: Preparing for civil unrest
← Read Part 2: Techniques to stay safe during civil unrest
← Read Part 3: Planning ahead in conflict zones
← Read Part 4: Responding to conflict threats in the field
← Read Part 5: First Aid – Assessing casualties, managing catastrophic bleedings
← Read Part 6: First Aid – Airway management and resuscitation
→ Read Part 8: Vehicle safety and road traffic collisions
→ Read Part 9: Let’s not forget digital security
→ Read Part 10: A step-by-step digital security protocol