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Disclaimer:
The writer is a last-year medical student with training in disaster medicine and acute life-threatening event management. The writer’s riot experience is limited to one city only. This article is not meant to precede the advice of your local activist group regarding the demands and dangers on the field.
Riot medicine is different from the conventional, hospital-based emergency medicine or the pre hospital-based disaster medicine. Some would say the main differences lay in the safety aspect of the job, the qualifications needed to be able to provide care (and thus the obligations that came with it), and the lack of a strata-based command line. We will address these differences in a moment.
The first step of being a riot medic is questioning yourself on why you want to be a riot medic. This step is important and non-negotiable. Sit down with yourself and ask why. If you wanted the thrill or the adrenaline of it, better go to a theme park. Medics who chase adrenaline will put patients at risk. Those who love anaesthesia and emergency medicine may perform exceptionally well in the job, but it is prudent to remember the legal and physical safety risks that might need to be sacrificed and if they are willing to do so. If you wanted to be an agent of change in a less direct way of harm and violence, please note that this is not always the case. Sometimes (and dare I say especially in the state of the world right now), being a medic will increase the risk of being targeted, harassed, and identified.
The second step is finding a community. Activist groups among university students are very common, there is one in every faculty even in the more cynical and pragmatic student bodies (COUGH such as CAR HONKS medical students TRAIN PASSES) (which is also why medics are a very limited resource in riots). This community will direct you to the right people to connect to and resources needed to be a riot medic.
The third step is learning the basics of first aid. If you’re already a practitioner or a medical student, the ATLS and ACLS materials are more than enough clinical basis to start. However, clinical knowledge alone is not enough. You need to know the setting and safety precautions needed. I highly recommend a Riot Medicine’s Bridge Guide to seal the gap in knowledge, but it is no substitute to reaching out to your local activist group to understand the level of violence that is usually faced by protestors and the police’s attitudes towards medics locally. For your first protest, I’d recommend being with someone with prior experience being a riot medic so their examples may guide you. Someone without formal medical education who has attended riots before as a medic will function so much better than a doctor without such experiences, who in many cases will feel overwhelmed by the chaos and the pronounced lack of equipment they are well-acquainted with in hospitals.
If you have absolutely no prior medical knowledge, you can always ask the available medics to teach and run hands-on simulations for you. Alternatively, you can also find the nearest and cheapest first-aid programs (certification doesn’t matter, as long as you can do what’s in the curriculum). The Riot Medicine website provides a handy pdf for absolute beginners covering organizations, pre-action planning, equipment needed, various medical emergencies assessment and treatment, as well as general precautions and tactics. Youtube also has many first aid contents that you can access for free. However, having a knowledgeable friend who can assist and correct you in your learning journey is important.
Safety for a medic is paramount. You will not be able to provide care if you’re not in one piece. The personal protective equipment (PPE) recommendation will vary across regions according to the level of police’s viciousness. Make sure to consult your local activist group for this. The ideal PPE should be protective enough against heat and riot control agents, does not impede your mobility, and does not make you stand out from the crowd. If the masses wear little, you should wear little too. Wearing too much PPE will make you a target in the police’s eyes, even as far as labeling you as a person with “passive weapon” (whatever that is supposed to mean).
On the field, medics work in “buddy unit”, which is two-person team responsible for each other’s task completion and physical and mental well-being. Buddies work with each other pre-action (training and skills review, compiling relevant information regarding the protest, preparing and checking equipments availability), during action (watching out for police and other dangers, carrying medics bag, assisting each others in patient’s management), and post-action (debriefing, mental health check-in, reporting back to your activist group regarding arrests and injuries). It is not advisable to separate from your buddy unit.
The specific management of patients is way too long to be discussed here. However, there are some principles that should be followed no matter what kind of patient you might encounter. First, make sure that the place is safe from both the rioting party or the police. It will be comical to painstakingly take care of a patient only to get them hit by a stray molotov. During extraction of patients from dangerous settings, the patient may be disoriented or blinded by riot control agents. Notify them that you’re not a threat and obtain consent for extraction. The consent-taking will need to be brief, so a sentence such as “I’m a medic. Let’s get out of here!” is usually adequate. Second, ask for no identity and ask as little detail as possible. You can use close-ended questions such as “Did you get hit by a rubber bullet on the chest?” “Did you get hit on the head?” emphasizing on what is being done to the patient, not what the patient was doing when they acquired the injury. In patients who need to be referred to the emergency department, make sure to inform them that the police may search hospitals for protestors and honor their choices on the matter. Make sure that informed consent is given before calling ambulances. In patients who are unconscious, consent is implied.
The cases you will find in riots will differ from place to place. In cities where demonstrations are mostly peaceful and the police docile, people will most likely approach you asking for masks before they somehow forgot to bring their own, for drinking water, asthma cases, allergy cases, heat strokes or hypothermia, or fainting. In places where the police are violent, abrasions, lacerations, ocular irritation to trauma, skin irritation, head traumas, musculoskeletal trauma, burns, and panic attacks are frequent.
The last part of this article will be discussing on what to be done when you’re faced by a fucking pig, which may be formally known as a police. This is where your activists group’s advice is most useful, as their level of viciousness and disregard of democracy varies are not the same across the globe. The general principle are protection of your patients’ identity. You can tell them in your most professional manner that doing so is violating patient’s confidentiality. When police get violent, do not leave your patient, carry them if possible. Insist on giving care to patients even through barricades and physical restraints.
What if it was a police that need medical attention? Unless it was a life-or-death emergency, it is inadvisable to help a police. The police are known to attack and arrest medics, even the ones who attended them. Furthermore, he police have their own medics, they are trained in first aid and have better PPEs than most protestors. Remember, the number of unaffiliated medics are limited and the protestors in need of care many. Any time that is given to care for a police is time not given to care for protestors.