The World Health Organization’s (WHO) emergencies department is facing „existential threats“ because of the growing number of health crises that have left it so cash-strapped that, at the end of last year, it needed emergency funds to pay staff salaries.
This document, which was made public ahead of the WHO’s annual meeting in Geneva this week, stated that it will probably have to reapply for funding in order to pay salaries through June.
The department handled 72 emergencies in 2023. These included massive worldwide cholera outbreaks, earthquakes in Turkey and Syria, and conflicts in Sudan, Ukraine, and Gaza.
A public health emergency
According to the report by an independent oversight committee, in order to meet the growing demands, countries should step up their own preparedness initiatives, and the WHO should enhance the way it assigns duties to national authorities.
In addition, it suggests new protocols for the WHO’s handling of protracted humanitarian crises as opposed to the acute illness outbreaks that the department also handles.
The document states that „more frequent natural disasters and conflicts in fragile states pose existential threats“ to the effectiveness of the emergency program. Furthermore, the WHO’s emergencies program „will be obliged to cut back critical activities“ if countries do not increase their capacity.
A „public health emergency of international concern,“ or PHEIC, is the highest level of alert in the WHO’s grading system for emergencies. The WHO declared the end of the emergency for both Covid-19 and mpox in 2023, leaving only polio at this level.
But the organization also handles a growing number of other crises, such as floods, infectious disease outbreaks, and conflicts.
Additionally, the WHO’s emergencies program had a „critical“ funding gap of US$411 million (RM1.9 billion), or nearly a third of its total budget, last year, the report stated, even though the organization’s overall budget was „relatively well funded.“
The report will be discussed by member states today after they have taken action to reform WHO funding.
In many countries, first aid courses are mandatory in order to obtain a driver’s license, or employers must train a certain number of employees as first aiders (company paramedics). However, these courses can also be attended independently at any time – this is also strongly recommended in order to be able to react correctly in an emergency situation. Likewise, it is recommended to refresh the knowledge again and again so that the first aider can make the right decisions with a high level of self-confidence.
Germany
Life-saving immediate measures
n this course, only life-saving immediate measures (LSM) from first aid were taught. The course lasted 4 lessons of 90 minutes each. Since April 1, 2015, the new first aid course (see below) has replaced the previous LSM training. After completing the LSM course, the participant should be able to act as an immediate / first aider at an accident site. In Germany, presentation of the certificate of attendance was a prerequisite for obtaining driver’s license classes AM, A1, A2, A, B, BE, L and T. Older LSM certificates were still valid for obtaining a driver’s license until October 21, 2017; since then, only first aid courses have been accepted. Attendance was also required for obtaining a private pilot’s license (PPL).
A legal obligation to repeat the course is not provided by the Driver’s License Ordinance (FeV § 19 FEV). The Road Traffic Act (§ 2 Para. 2 No. 6 StVG) stipulates that applicants for a driving license must be able to provide first aid. According to general recommendations, the knowledge should be refreshed every 2 to max. 3 years.
First aid course
In this course, the measures for the first aid of vital threatened persons are to be taught. The knowledge that can be acquired here is helpful and even life-saving in many emergencies that can occur in the private and professional environment. To a large extent, this involves respiratory and circulatory emergencies. The treatment of injuries, burns, shock and poisoning is also taught. The duration comprises 9 teaching units of 45 minutes each (before April 1, 2015: 8 teaching units of 90 minutes each).
The course is compulsory in Germany for all driver’s license classes, for the acquisition of the passenger transport license, the youth leader card and for admission to the physics examination. The employers‘ liability insurance associations require repetition every two years, with the repetition training for company first aiders comprising 9 teaching units of 45 minutes each (before April 1, 2015: 4 teaching units of 90 minutes each).
The training in a first aid course imparts, among other things, the following knowledge:
Behavior at the emergency scene
First link of the rescue chain: securing, self-protection, emergency call, immediate measures
Second link of the rescue chain: first aid/other measures in case of:
Shock as a life-threatening condition
Wounds and wound care, hemostasis
Poisoning (e.g., with alcohol, medications, carbon dioxide, carbon monoxide, pesticides, chemicals, or drugs)
seizure (epilepsy) and stroke (cerebral infarction)
thermal injuries (burns, frostbite and hypothermia)
chemical burns
insect bites (especially in the mouth and throat)
violent impact on the head (head injury), concussion
choking (swallowing of foreign bodies)
Abdominal injuries, acute abdominal illnesses with nausea and diarrhea or vomiting
Cardiovascular disorders (cardiac arrest, heart attack, stroke and arrhythmia)
Bone and joint injuries
Mental care of the casualty/patient
Third link in the rescue chain: rescue service
Fourth link in the rescue chain: hospital
Since 2005, the rescue chain has been specified in four links. The previous separation between the „immediate measures“ and the „emergency call“ has been abolished; the emergency call is made as far as possible in parallel with the other immediate measures.
There is no final examination of the acquired knowledge and the learned practical skills. Only the participation is certified. References to the possibly mental care of traumatized first responders after e.g. serious accidents are not given
Special first aid courses
Meanwhile, many aid organizations and other approved providers offer customized training courses, for example for members of special risk groups:
First aid in children’s emergencies (for parents, grandparents, educators and other supervisors of children up to approx. 10 years)
First aid in sports accidents (for sports teachers, exercise instructors, trainers)
First aid for seniors
First aid for the disabled
First aid for cardiovascular patients
First aid in outdoor areas, including specific courses for first aid in alpine areas
First aid for seafarers (extended courses that include, for example, placing infusions)
First aid courses delivered online and introduced during the COVID 19 pandemic
On the other hand, there are courses that are tailored to specific groups of first responders:
First aid for medical students
First aid for road traffic
First aid for company first aiders
First aid for private and domestic use
First aid for children, adolescents, mentally or physically handicapped persons
First aid for soldiers of the German Armed Forces
First aid for professional trainers of sports associations
Some of these courses are also held in cooperation with schools, kindergartens or facilities for the disabled.
New to the program are the courses „Life-saving immediate measures with self-protection content“ and also „First aid with self-protection content“, which correspond in content to a course in life-saving immediate measures or first aid and have been supplemented with topics from civil and population protection. These courses are only financed 100% by the federal government if the very narrow requirements are met (note: funding is limited). The requirements include a very narrow age range of participants (14 to 16 years) and a maximum of 15 participants per course.
Company first aider
In every company in Germany, a sufficient number of trained company first aiders must be „available“ according to § 10 ArbSchG and specified in § 26 of DGUV Regulation 1. These company first aiders must, as mentioned above, undergo training comprising 9 training units. A suitable refresher course of 9 units must be attended every two years at the latest. Depending on the type of company, between 5 and 10 % first aiders are given as a guideline. A first aider is required for as few as two employees. The use of the first aid kit must be documented in the first aid manual.
Paramedic courses
Paramedic courses are sometimes offered as general training or serve as training for civil protection (disaster control/civil defense).
For some occupational groups (personal and property protection, for all weapon carriers, for service dog handlers), paramedic training is mandatory. The paramedic training requires a basic training in first aid (usually with at least 9 teaching units). In addition, the employers‘ liability insurance associations stipulate that, depending on the size of the company, an appropriate number of first aiders must be present (from two members of staff). Only licensed physicians and dentists are considered first aiders without any special training. From a certain company size, training as a company paramedic is mandatory (from 1500 staff members present, on construction sites from 100). This training takes considerably longer than a normal first aid course (first aid = 9 teaching units. versus company paramedic training = (at least) 95 teaching units, whereby the latter builds on a first aid course) and also includes the basics of medical assistance. The training is divided into a basic and an advanced course (paramedic, paramedic, paramedic assistant as well as the training to become a nurse and a medical sergeant in the German Armed Forces are recognized as basic training). At least every three years, the company paramedic training must be refreshed by a 16-hour continuing education course. Training and continuing education may only be conducted by so-called authorized bodies. Equivalent to the company paramedics are the so-called remedial assistants according to the mountain ordinances. (Source: Accident Prevention Regulation – DGUV Regulation 1, Principles of Prevention, BGV A1 and Employer’s Liability Insurance Association Principles, BGG 949, published by the German Federation of Institutions for Statutory Accident Insurance and Prevention, as of January 1, 2004)
Advanced courses
Courses or vocational training that go far beyond imparting first aid knowledge for first aiders include, for example, courses for on-site helpers (D only), rescue assistants (D only), paramedics (D, Ö) and emergency paramedics (D, Ö). In 2014, the professional training for emergency paramedic replaced that of the paramedic, who could further qualify to this through further training. Information on these training courses can be found under the corresponding keywords. The paramedic and emergency paramedic is a vocational training in Germany. In Austria, this applies to training as a paramedic as well as an emergency paramedic.
Austria
Scope
The curriculum for the first aid course in Austria has the following structure:
Why should you give first aid?
First aid equipment
Basics of first aid:
Rescue chain: securing, providing first aid and making an emergency call (in parallel), rescue service, further care
Tasks of the first aider
Danger zones, securing, recognizing, requesting special forces
Emergency call: possibilities, which questions are asked, emergency numbers and other important telephone numbers
Helmet removal, pull away, rescue (formerly „salvage“) with the hash handle
Emergency check
turn over (from prone position to supine position), pull away, get someone onto a blanket
Acute emergencies – recognize each and initial measures
Heart attack
Stroke
Seizure
Diabetes
Asthma attack
Collapse
sunstroke
Ingestion
Poisoning
Allergic reaction
Severe bleeding (pressure bandage, finger pressure)
Wounds
Bandages
Head bandage, hand bandage, knee bandage with triangular cloth
Nosebleed
Animal bite
Foreign body in the wound
Burn
Chemical burn
Bone and joint injuries
Arm injury (arm sling)
Leg injury
Sprain
Duration and types
The following types of first aid courses are usually offered:
16 hours basic course – required for driver’s license D (bus)
4 hours refresher course
8 hours refresher course
Children’s emergency courses (4 to 16 hours)
6 hours driver’s license course (immediate measures at the scene of an accident) – is required for driver’s license B
Instruction for defibrillators and various special courses
Company first aider
According to the Workplace Ordinance (AStV), company first aiders must be trained in companies (§ 40 AStV).
In offices or workplaces with a comparable accident risk:
1 first aider for up to 29 regularly employed workers at the same time
2 first aiders for 30 to 49 employees regularly employed at the same time
one additional first aider for every 20 additional employees regularly employed at the same time.
in all other workplaces:
1 first aider for up to 19 regularly employed workers at the same time
2 first aiders for 20 to 29 employees regularly employed at the same time
one additional first aider for every 10 additional employees regularly employed at the same time.
for construction sites:
1 first aider for up to 19 workers employed by an employer on a construction site.
2 first aiders for 20 to 29 regularly employed workers
one additional first aider for every 10 additional workers regularly employed by an employer on a construction site
First responders must have at least 16 hours of training (eight hours in companies with fewer than five employees). An eight-hour refresher must be completed every four years, or alternatively a four-hour refresher every two years.
Switzerland
Providers and offers
In Switzerland, several Swiss Red Cross organizations, namely the Sameriter Schweiz, the Swiss Life Saving Society (SLRG) and the Swiss Military Medical Association offer first aid courses on a non-commercial basis. The second major provider, the Swiss Medical Corps – an association of doctors, paramedics and trainers – mostly works with commercial partners (mainly driving instructors, Migros Club School, TCS).
The Inter Association for Rescue (IVR) certifies and standardizes a large part of the training courses. As an example, an overview of the courses offered by the Samaritan Association:
Course
Content
Target group
Duration of the course (in hours)
Validity period of the ID card (in years)
Prerequisite
Emergency helper course
According to Art. 10 VZV: securing the accident site, alerting, preservation of vital bodily functions, positioning of the injured person, ventilation, severe bleeding, basics of cardiac massage.
Learner drivers (categories A, A1, B and B1) must have a valid ID card
10
6
none
First aider IVR 1
General first aid in everyday situations (traffic, household, workplace, leisure) and correct alerting. The first aider can implement instructions from the emergency call center according to the situation. Participants will also receive certificates for the emergency responder course and BLS-AED-SRC.
general
14
2(respectively 6 and 3)
none
First aider IVR 2
Formerly known as the „Samaritan Course.“ Deepens and expands first responder IVR 1, including: Assessing, providing initial care, and observing accidental bodily injury and acute illness until professional help arrives; assessing whether and what professional help needs to be called for; level-appropriate classification of hazardous situations.
z. e.g. youth group leaders, sports coaches, part-time company paramedics
14
2
IVR 1 or emergency responder + BLS-AED-SRC
First aider IVR 3
Link to professional rescue. Differentiated situation assessment, best possible care of the patient based on available resources. Assists emergency physician and paramedic.
z. e.g. part-time or full-time company paramedics
42
1
IVR 2
BLS-AED-SRC
Ventilation, cardiac massage and use of a defibrillator according to the guidelines of the Swiss Resuscitation Council.
in general, but especially relatives of heart patients, police officers, firefighters, fitness instructors
4
3
none
Emergencies in young children
Hazard recognition, patient assessment, ingestion of objects, resuscitation.
Parents, childcare workers
4
unlimited
none
First aid part of the CZV course
According to annex CZV, number 3.5: situation assessment, avoidance of secondary accidents, alerting, rescue and first aid, behavior/evacuation in case of fire, procedure in case of violence, preparation of accident reports.
Compulsory for persons who professionally drive vehicles in categories C, C1, D or D1.
2 X 8
5
none (de facto emergency helper course, due to previous learning license category B)
If repeat courses are attended within the period of validity, the validity is extended. There is no obligation to repeat courses, but employers (in the case of company paramedics), sports associations or youth organizations, for example, insist that first aiders have a valid card in each case.
Specialized first aid courses are offered by:
SLRG: Accidents during bathing, swimming and water sports
Swiss Alpine Club: Emergencies in mountain sports
History
The Military First Aid Association of Berne was founded in 1880 to provide first aid services at major civilian events (e.g. gymnastics and shooting festivals). In 1885, also in Bern, the first Samaritan Association was founded, and in 1888 the Swiss Samaritan Federation. Since 1965, Samaritan associations have offered emergency courses to the public, and since 1977, attendance at an emergency course has been compulsory for learner drivers. The Samaritan Association introduced resuscitation courses in 1993.
Operational Health
In Switzerland, there is no more precise legal regulation of industrial hygiene; the law stipulates that, depending on the operational hazards, location and size of the operation, the „necessary means“ must be available and that, if necessary, trained industrial paramedics and first-aid rooms must be available. For judicial practice (e.g. liability issues), the guidelines of the State Secretariat for Economic Affairs (SECO) and those of the various industry associations are binding.
Kneel next to the unconscious person’s upper body. Place one hand on the center of the chest so that the heel of your hand rests on the lower half of the sternum. Then place your other hand on top of it, interlace your fingers and extend your arms through. Be careful not to slip sideways onto your ribs or place your hands too far down, such as on the top of your sternum or stomach.
Now shift your torso forward with your arms outstretched to push your rib cage in – and back again so that it lifts completely. Press the rib cage in between 5 and 6 inches deep with each movement. Repeat this sequence of movements briskly so that you are pushing the chest in about twice per second (per minute 100 to 120 times). Make sure that your arms remain extended at the elbow joint, otherwise you will tire very quickly.
Even if a child is unconscious and no longer breathing normally, the following applies: Do not hesitate with resuscitation! If you proceed in the same way as with an adult, this is better for the child than no resuscitation at all. On the website of the German Red Cross you can learn what to consider when resuscitating children.
Cardiac massage is strenuous. To save strength, you should therefore alternate with someone every two minutes, if possible.
Cardiopulmonary resuscitation in infants and young children
Cardiopulmonary resuscitation is performed whenever unconsciousness and no normal breathing can be detected or there is doubt that normal breathing is present. If two or more rescuers are on scene, tasks can be divided. During cardiopulmonary resuscitation, rescuers should take turns after about two minutes to avoid fatigue.
For infants and children, cardiopulmonary resuscitation should be adapted to the age-related respiratory rhythm, respiratory volume and corresponding heart rate.
Because of the higher risk in children and infants of airway obstruction by foreign bodies, up to five initial rescue breaths should be administered before starting chest compressions. If a rescue breath cannot be administered, only chest compressions are performed.
Cardiac massage for infants and young children
Undress the infant/toddler as far as absolutely necessary.
Begin chest compressions if normal breathing is not present after rechecking breathing or if there is any doubt that normal breathing is present.
Special features of the infant
Place two fingertips of one hand on the center of the infant’s chest (lower third of the sternum).
Use two fingers to press the sternum down about one-third to one-half (approx. 4 cm) deep.
Special features of the toddler
Place the ball of one or two hands on the center of the rib cage (lower third of the sternum).
Bend over the child’s chest and, with an outstretched arm, press the sternum down about one-third to one-half (about 5 cm) deep. Make sure that the fingers do not rest on the chest.
Completely relieve the sternum after each compression without relinquishing contact between the hand and the child’s chest.
Press down on the sternum 30 times (frequency: 100- to max. 120 times per minute).
The duration of pressure and relief should be the same.
Combination cardiac massage with ventilation / rescue breathing for infants and young children
Administer up to 5 initial breaths before starting chest compressions.
After 30 chest compressions, reopen the airway and ventilate the infant/toddler.
Continue the resuscitation measures in the ratio of 30 cardiac pressure massages to two breaths in rapid alternation continuously over a period of one minute.
Emergency call 112: If the rescuer is alone and the emergency call has not yet been made (by a second rescuer), interrupt resuscitation measures after one minute and make the emergency call.
Special features of the toddler
If an AED device is nearby, get it or arrange for it.
Connect the device (if necessary using adhesive child electrodes for children between one and eight years of age) to the affected child and follow the further voice instructions of the AED device.
Continue resuscitation efforts on infant
Then continue resuscitation measures (cardiac massage/breathing) in constant alternation at a 30:2 rhythm until the infant/toddler begins to breathe normally again, the rescue service arrives and continues the measures or the rescuer is exhausted.
Completing cardiopulmonary resuscitation in infants and young children
You can stop cardiopulmonary resuscitation if
breathing resumes (if unconsciousness persists, the injured infant/infant must be placed in the recovery position, if possible).
the rescue service arrives and takes over the measures on site without interruption.
If someone has a circulatory arrest, immediate resuscitation is very important. It can be life-saving, for example after a heart attack.
In an emergency in a hospital or doctor’s office, doctors and medical staff can quickly take special measures. Everywhere else, however, immediate first aid by medical laypersons is essential.
In an emergency, the most important thing is to stay calm and adhere to the following regimen:
Check if the person is unconscious and not breathing normally.
Call the emergency number 112.
Start with chest compressions.
If you follow these three steps quickly, you will do everything right. Above all, it is important to start resuscitation immediately! Do not hesitate to do something wrong out of fear.
Good to know: As an untrained layperson, you do not have to ventilate the unconscious person.
If an automated external defibrillator (AED) is available and another person is present, you can supplement resuscitation with this device. However, make sure that you only interrupt chest compressions when the device prompts you to do so.
How do you check if someone is unconscious?
Speak to the person loudly and clearly (for example, „Hello! Can you hear me?“) and gently but firmly shake their shoulder. If the person does not respond, you can assume that he or she is unconscious.
How can you tell if someone is no longer breathing normally?
Drehen Sie die bewusstlose Person auf den Rücken. Fassen Sie ihr unter das Kinn und legen Sie ihr den Kopf in den Nacken, damit die Atemwege frei sind. Sie erkennen einen Atemstillstand daran, dass sich der Brustkorb nicht mehr bewegt und Sie weder ein Atemgeräusch hören noch einen Lufthauch spüren, wenn Sie Ihr Ohr nah über Mund und Nase der bewusstlosen Person halten.
In den ersten Minuten nach einem Kreislaufstillstand kann es sein, dass die betroffene Person noch atmet – ihre Atemzüge sind dann jedoch nicht normal, sondern
irregularly,
particularly slow,
particularly deep or
associated with a snoring-like sound.
Do not under any circumstances wait until breathing stops completely. If after ten seconds you still have doubts as to whether the unconscious person is breathing normally, you should make the emergency call and start resuscitation.
What should be considered when making an emergency call?
If there are other people present besides you, speak to someone directly and ask him or her to take over the emergency call. Then you can start resuscitation immediately.
If you are alone, call 112 yourself. This emergency number is available throughout Europe, is free of charge and can also be used in many countries outside Europe.
The employee at the emergency call center will ask you the following five „W questions“. Answer all the questions calmly and accurately:
Where did it happen?
Specify the location as accurately as possible (for example, address, floor, street mileage).
Who is calling?
Include your name, location, and phone number for possible questions.
What happened?
Describe concisely what they see that happened (for example, traffic accident, fire, unconscious person).
How many people are involved?
If possible, indicate the number of people involved and their injuries. For children, also the age if possible.
Waiting for further inquiries!
Legen Sie nicht sofort auf. Ihr Gegenüber in der Leitstelle benötigt vielleicht noch mehr Informationen.
Wenn möglich, schalten Sie den Lautsprecher ihres Telefons ein („Freisprechen“) und bleiben mit der Notrufzentrale in Verbindung. So kann das Personal der Notrufzentrale Sie telefonisch bei der Wiederbelebung unterstützen.
