If you’re reading this, you likely know me as a doctor who focuses on performance, prevention, and longevity. But, I also have formal training and a current practice in emergency medicine. Sitting at the intersection of emergency medicine and longevity medicine has allowed me to see that the field of longevity medicine should not neglect to encourage people to prepare for treatable emergencies. How tragic is it to imagine an individual who invests in an aggressive approach to avoiding chronic disease, only for them to perish from a treatable emergency?
According to the CDC, unintentional injuries account for 24.8 million office visits and 97.9 million emergency visits annually. There are over 200,000 annual deaths from accidental injuries, which makes accidents the 4th leading cause of death overall, and the leading cause of death for those under age 44.
Accidents like falls, motor vehicle collisions, and choking are significant causes of premature death and debility. Sudden cardiac death accounts for 356,000 annual deaths in the US, over 7,000 of which occur in young persons and athletes. There are relatively simple techniques and equipment that trained lay-persons can learn to use in order to save themselves or loved ones from such emergencies.
Is there anything we can do to prevent falls or to treat them once they’ve happened? Death by falling is a problem almost exclusive to the debilitated and elderly. In 2019, 34,000 deaths in individuals over the age of 65 were attributable to falls. Once an elderly individual is prone to falls, there are preventive measures that can be taken. However, I’d argue that by the time we’re prone to death or debility from a ground level fall, the horse has already left the barn. Part of a complete longevity plan is a well formulated exercise regimen that mitigates the losses in strength, stability, reaction time, and grip that we all endure as we age.
One simple intervention that can help reduce fall risk in the elderly is to ensure that they have (appropriately) minimalist and well-fitting footwear. There is limited research (PROFET, Lightbody et al. 2002) to back this up, but my own observation of the elderly in my personal and professional life demonstrates that footwear matters. There are two types of footwear that I find particularly treacherous. The first offender is the slipper, whose name is self-explanatory and needs no further elaboration. The second problematic shoe is the bulky sneaker with a thick insole and outsole.
What better way to trip-up our elderly than to make them lift their feet a few extra inches with each step just to avoid tripping over their own shoes? Also notice the front and back end of this sneaker; over-hanging bumpers which are ripe for toe-stubbing and tripping. Furthermore, the thicker and more cushioned the sole, the less the foot can feel the ground. Reducing proprioceptive feedback makes stable ambulation more difficult, and increases fall risk. There are many options for zero-drop or minimalist footwear (e.g. Xero, Lems, Altra, and many others), but whether you like zero-drop shoes or not, the point is to minimize excess material and get the sole of the foot closer to the ground.
A second group of people prone to serious injury or death from falls are those whose work puts them at risk. The National Safety Council, estimates that 805 workers died from falls in 2020 and greater than 200,000 were injured badly enough to require time away from work.
While preventing workplace falls is outside the scope of this discussion, managing potentially fatal injuries from a serious fall is not. For instance, I’ll indicate below how to prepare for a cardiac arrest (which can either cause a fall or result from one) and how to prepare for life-threatening bleeding (which can also be caused by a fall).
Death by traffic accident is more age agnostic, but is a particularly high risk for teens and those in middle-age.
We can reduce our risk of having a traffic accident, and reduce the risk that an accident is fatal. The obvious precautions here apply: seatbelts, safe speeds, and alertness.
A well known style of driving advocated by road-safety experts is called “defensive driving.” My personal spin on this is to assume that everyone on the road is trying to kill me, and to stay out of their way as much as possible. I watch the vehicles around me and imagine the worst driving mistake they might make, and then I place my vehicle accordingly.
While few motorists are homicidal, it’s a fact that a massive number of drivers are impaired in one way or another. As an emergency physician, I see many victims and perpetrators of motor vehicle collisions. It’s important to know that people have strokes, heart attacks, and seizures while driving; at times, people faint behind the wheel. People with poor vision, neurologic disorders, and psychiatric disorders all drive vehicles. People who are sleep deprived, on sedative medications, who are under the influence of alcohol and drugs, and people who regularly practice distracted driving, are all behind the wheel every time you get on the road. I see these patients in the emergency department regularly. For all intents and purposes, these people are trying to kill you. Act accordingly, and you might stay out of their way.
It’s also worth evaluating and improving our defensive driving skills. Most of us consider ourselves to be just as good as Max Verstappen as we zip in and out of traffic on the freeway.
No matter our driving record, few of us have ever been trained in emergency braking or taken a spin on the skid pad. I was fortunate enough to recently have these experiences at the BMW Driver’s School. BMW has locations in Spartanburg, SC, Thermal, CA, and Indianapolis, Indiana. Even if a BMW driving class isn’t in the cards, there are lots of driving schools in every state. This is an especially good idea for teens, who (author included), unjustifiably believe they’re experts behind the wheel.
Since none of my articles would be quite complete without mentioning Peter Attia, I’ll also suggest that you read his article on traffic accidents for a primer on their causes and how to avoid them.
Life Threatening Bleeding
The Global Burden of Disease, Injuries, and Risk Factors Study of 2010 estimated that 60,000 annual deaths in the US are attributable to hemorrhage. Trauma accounts for roughly 50,000 of these. This category undoubtedly has some overlap with the two that precede it. So, while this category is not exclusive of the others, those who suffer lacerations from falls or traffic accidents are among the potentially treatable victims.
First aid for life threatening external bleeding is actually relatively straightforward. There are three key concepts that any layperson can use to stop bleeding.
The first concept is direct pressure. Direct pressure is useful when there is a small localized source of bleeding, like a small laceration, that responds to direct pressure. The more direct the pressure, the better. If there is a pinpoint location of bleeding, you’re better off concentrating all of the pressure over this tiny point with a finger or a small bandage applied under pressure. This is in contrast to what is often depicted on television, which is a bystander applying a bunched-up t-shirt over a small wound. This applies minimal pressure to the actual source of bleeding and does little to help.
The second principal is to apply a tourniquet proximal to an injury that won’t respond to direct pressure, or one that is bleeding under pressure from an artery. Tourniquets can be fashioned from everyday materials, but it’s preferable to carry a tactical tourniquet. More information on tourniquets is provided at the end of this article.
The third concept is packing. This technique should be used when there is a large gaping wound that is bleeding from a large surface area. If the area is not on an extremity, and thus can’t be treated with a tourniquet, the final option is to pack the wound tightly with gauze or fabric.
Another preventable cause of death is choking, which accounts for roughly 5,000 annual deaths in the US.
Many of these deaths are in children under the age of four, and many others are in elderly and disabled individuals who may have trouble swallowing and have weak or abnormal airway reflexes. However, some of them occur in otherwise perfectly healthy people in middle age. Unlike traffic accidents, which are largely mitigated and prevented by you, the driver, to be saved from choking, the victim usually requires help from another. However, this isn’t always the case. It is possible to perform the Heimlich maneuver on oneself, as this case report proves.
What’s more likely is that you’ll have the chance to save a loved one from choking. Understanding physical maneuvers to dislodge a tracheal obstruction and being ready with a device like the DeChoker or LifeVac can save a life. Resources are listed at the end of the article.
Sudden cardiac death, which has many underlying causes, occurs 356,000 times each year. Ninety-percent occur in residences and public settings. Of these, 37% are witnessed by a layperson.
I was surprised to read that laypeople initiated CPR in nearly 41% of witnessed out-of-hospital cardiac arrest cases. I’d have guessed a much lower number. However, AEDs (Automated External Defibrillators) were used in only 9% of cases. It’s unclear from these data how often an AED was available.
Even when bystander CPR is initiated, survival is unlikely. Only 7% of EMS (emergency medical services) treated out-of-hospital cardiac arrest patients survived with a good functional status. However, the survival rates are quite a bit better for children (13%) and for sports-related cardiac arrest (43.8%).
If bystander CPR were initiated more frequently, perhaps survival rates would improve. One thing is certain, without bystander CPR, victims stand almost no chance at all.
You might think to yourself that bystander CPR is meaningless and that you can’t make a difference. However, CPR is the only chance you can give someone whose heart has stopped. When an individual’s heart stops beating effectively, they quickly lose consciousness due to decreased cerebral perfusion (blood flow to the brain). If effective CPR is not initiated within a few minutes, the brain and heart will become anoxic (starved of oxygen). At this point, the likelihood of getting the heart to beat effectively becomes less with each passing moment. After 3-5 minutes of poor cerebral perfusion, brain death occurs rapidly. At this point, even if the heart is restarted, the brain is unlikely to recover. CPR helps to ventilate the lungs and helps to pump blood so that the brain can get enough oxygen while you buy time for a loved one to get more help.
An amazing example of successful CPR is the story of ophthalmologist Will Flanary. Flanary is not only an ophthalmologist, but a brilliant speaker and comedian. He has 2 million followers on TikTok and 654,000 followers on Twitter where he’s known as @DGlaucomflecken. In 2020, he had a VF (ventricular fibrillation) cardiac arrest while asleep at home in his bed. His wife (who has no medical training) recognized the arrest and performed 10 minutes of effective CPR while simultaneously directing EMS to their home. He was cared for by EMS, hospitalized, and made a rapid and full recovery.
You can watch Dr. Flanary and his wife talk about this remarkable and harrowing experience here:
Learning CPR and learning how to use an AED are two skills you can learn that might save the life of a loved one.
While these scenarios might seem far fetched, the above skills are relatively easy to learn and might save your life or the life of a loved one. The devices and didactics listed at the end of the article are easier, faster, and cheaper to obtain and learn than almost any longevity strategy or tactic that I use in my longevity practice. In other words, I believe that preparing for a handful of emergencies is an efficient use of time and money. The cost is low and the potential benefits are enormous. Please consider preparing yourself with some knowledge and a few key items in case of an emergency.
Decide in Advance
One final word on dealing with emergencies: we may only have one moment in our lives when we’re confronted with an emergency and have the opportunity to act. The hardest part is the decision to act. I’ve experienced first hand, that preparation, study, visualization, and simulation can prepare us mentally to be ready to act when an emergency occurs. There are several critical life-saving procedures that I’ve done only once in my career as an ER physician. I was able to do them successfully because I had mentally prepared myself and decided far in advance that if the scenario ever arose, no matter what, I would act. On the other hand, I’m aware of scenarios in which people were unable to act and missed critical opportunities to save lives. To guarantee that we’ll act in an emergency, we have to make that decision in advance. If we leave it up to the moment to decide, there is a chance we’ll freeze or delay, a mistake we and our loved ones can’t afford.
Survival Essentials Didactics and Purchase List
Sudden Cardiac Death
Educate yourself on CPR and AED usage and prepare yourself mentally for taking action if such a scenario occurs. You can watch this excellent and up-to-date 5-minute CPR training video with AED demo. Sometimes, CPR may require rescue breaths. If you own and carry a Laerdal Pocket Mask, you may be able to deliver effective rescue breaths while protecting yourself.
Stopping Life-Threatening Bleeding
You’ll need to own and carry a tourniquet and be familiar with public access bleeding control kits. You can purchase a certified combat tourniquet from North American Rescue (NAR).
IMPORTANT! — SPECIAL ATTENTION FRUGAL SHOPPERS
- You need to buy tourniquets from North American Rescue and not Amazon or any other 3rd party seller.
- This is not a product that you can or should save money on. There are tons of cheap knockoffs that will break when applied properly. Saving $5 dollars on this product means trading your life or a loved one’s life for $5.
This 6 minute training video will teach you how to apply a combat application tourniquet. This 2 minute video will teach you how to improvise a tourniquet using a strip of fabric and any rigid oblong object as a windlass.
If you’re in a public place, there’s a chance you might be able to find a public access bleeding control kit. You should be familiar with these and how to use them.
North American Rescue has an excellent training video that you can watch here.
I recommend purchasing and preparing to use a commercial device like the DeChoker or LifeVac. These devices have been used successfully in the real world to rescue adults and children from choking. It’s useful to have them in your kitchen and in your vehicle. The DeChoker website is a wealth of information. You can use this link to watch their training video.
Asthma and Anaphylaxis
If you or a family member have a history of asthma or allergic reactions, I recommend asking your doctor for an epipen (requires a prescription). Keep an updated (non-expired) epipen at home and one in your vehicle or bag that you travel with. Learn how the device works and how to use it.
The information on this website is meant for educational purposes only. It is not intended as medical advice or as a substitute for professional medical care. If you have a medical problem or concern, you should seek assistance from your physician. If you are concerned that you are experiencing a medical emergency, you should seek help from your local emergency services. The use of this website and the information contained herein is at your own risk, and does not constitute a doctor patient relationship.
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