KEY POINTS
- In a sudden emergency there is a ‘leadership void’ that needs to be filled if the situation is to be well managed.
- A good leader steps back to survey the whole scene.
- Being a good follower is a skill: be supportive and communicate actively and thoughtfully.
EXPLANATION
Accident scenes can be chaotic. In the seconds following a crash, people are often too stunned to move. Then suddenly, everyone rushes into life, all with different ideas and priorities. Some will want to take over, some will want to run and hide but fundamentally, everyone is looking for a leader and a task. We all need to feel like we are doing something useful in a crisis.
Stepping up to fill the leadership void is a difficult thing, particularly amongst a group of friends. It can feel exposed and some worry about being thought of as pushy or arrogant. Actually, most groups are utterly relieved when one person volunteers to be the leader.
A leader does not have to be the one with the most medical knowledge. Indeed, often it is best that those with medical experience don’t take overall charge. They will be most useful applying all their energy to looking after the casualty.
We prefer to use the word ‘coordinator’ rather than leader. It carries less emotional charge and is a more accurate description of the role. We would encourage you to be brave. If you are faced with an accident, then step up and say ‘I will coordinate this situation’. It will make the world of difference to how the rest of the day unfolds.
When you are coordinating, please try to stand back. Your job is not to be hands-on, it is to take a global view and delegate wherever possible. This too can be very hard. Even though it feels the opposite, the less you are physically doing, the better a coordinator you are.
Don’t forget to think out loud. During stressful situations, we often internalise – however, thinking out loud will help marshal your own thoughts, as well as giving your group a sense of direction.
If someone else has volunteered to coordinate, then try to fall in behind them. Recognise their courage in putting themselves forward and do your best to support them. Clearly, that does not mean unquestioning obedience – of course you should speak up if you think events are moving in the wrong direction. However, if you are given a sensible task then do your best to get on with it.
Be conscious that the coordinator will be being bombarded with information and questions. This is called decision fatigue and is a recognised problem. As a follower, tell the leader only what is necessary when you speak to them. Try to pose a solution along with your question. If you are given a task, verbally confirm that you have understood and report back when it is completed. Finally, give the leader plenty of encouragement during and after the event.
The First Moments of Coordination
When you step forward, your first job is not to start doing things but to pause and look. Take three slow breaths, then scan the scene. Where is the casualty? What dangers remain? Who is already helping? This initial survey takes only seconds but prevents you from rushing into a mistake.
As coordinator, you should keep your hands free and your voice calm. Do not kneel down to treat the casualty yourself unless there is no one else and you have particular skills. Your role is to direct, not to do. Point at people and name them: 'You in the blue jacket, call 999 and come back to me.' 'You with the dog, can you stop traffic from that direction?' Clear, specific instructions work far better than general appeals.
Write things down if you can, even on the back of a receipt or in your phone notes. Note the time of the accident, the number of casualties, and what tasks you have given out. This record will be invaluable when the emergency services arrive and you need to give a handover.
The Skilled Follower
Being a good follower does not mean standing around waiting. It means actively supporting the coordinator while staying within your skills. If you are asked to fetch a blanket, do it quickly and return. If you are asked to hold a casualty's head still, do not let go even if you get tired or bored. Tell the coordinator when you are struggling, but do not abandon your post.
A skilled follower also communicates clearly. Say 'I am doing X now' or 'I need a replacement in two minutes.' Do not whisper or shout across the scene. Use the coordinator as your central point of contact, not a series of side conversations. If you see a new danger or a change in the casualty, report it calmly and factually: 'The casualty's breathing has slowed,' not 'Oh my God, I think he is dying.'
Sometimes the best followership is to step away. If you are too shaken, too angry, or too inexperienced to help, say so early. There is no shame in admitting you cannot cope. A good coordinator will give you a safe, simple task like waiting at the road entrance to flag down the ambulance, or looking after a child who is not injured but frightened.
Managing the Crowd of Bystanders
In many accidents, the biggest problem is not the casualty but the crowd. People gather quickly, and each person wants to help, but too many helpers make things worse. Your job as coordinator is to turn that crowd into a resource, not a hindrance. Start by asking everyone who is not actively helping to take two steps back. Use a firm but friendly voice: 'Thank you all for stopping. Please give us space to work.'
Then assign roles to the most useful-looking individuals. The person who is filming on their phone can be asked to stop and instead note down times and events. The person who is crying or panicking can be given a simple, calming job such as holding a coat over the casualty to keep them warm, which keeps their hands busy and their mind focused. Avoid giving instructions to the whole group at once; pick individuals and use their names or clothing descriptions.
If someone refuses to follow instructions or becomes aggressive, do not argue with them. Step back, lower your voice, and repeat your request once. If they still do not cooperate, assign another bystander to stand between you and that person, or simply move the casualty away if it is safe to do so. Your priority is the casualty, not winning a confrontation.
Handing Over to Emergency Services
When the ambulance or fire crew arrives, do not disappear. The handover is one of the most important moments for the casualty's care. Walk to meet the crew, introduce yourself as the person who has been coordinating, and give a clear, structured report. Use a simple format: what happened, what you found, what you did, and what has changed. For example: 'Car hit a cyclist at about 2pm. Male, around 40, was unconscious for two minutes then woke confused. We have kept him still on the road, put a coat under his head. His breathing is normal but his left leg is bent oddly. No bleeding we can see.'
Do not feel you have to impress the professionals. They do not expect a perfect medical summary. They want the key facts: time, number of casualties, level of consciousness, any obvious injuries, and any first aid already given. If you wrote notes earlier, hand them over. If you are unsure about a detail, say 'I think' rather than guessing. A wrong guess can cause real harm.
Once the crew takes over, your role as coordinator ends, but you can still offer to help with simple tasks such as holding a drip bag or directing traffic if they ask. Then step back and let them work. You may feel a sudden wave of emotion once the pressure lifts. That is normal. Find a quiet spot, sit down, and drink some water. Talk to someone you trust about what you saw. The leadership void has been filled, and now your job is to look after yourself.