What is the relationship between first aid and emergency health care?

First aid is the “first piece of the puzzle” in an emergency health system. It serves as a crucial buffer zone that connects acute risks outside the hospital with standardized treatment inside the hospital. It not only plays a role in immediately preventing further harm in cases of sudden injuries but also represents the most direct link between public health protection networks and the lives of ordinary people.

Last summer, I was providing free medical consultations in an old residential area in Shangcheng District, Hangzhou. Just as I finished packing up and was about to leave, I heard someone shouting that someone had fainted over by the vegetable market. When I ran over, I saw Uncle Wang, who often came to get his blood pressure medication, collapsed beside a vegetable stall while picking eggplants—he had suffered a heart attack and had already lost consciousness. Aunt Zhang, who sells vegetables nearby, had just completed a first-aid training course in her community last month. She ran over immediately with an AED from the entrance of the market. After performing chest compressions and administering a shock, within less than three minutes, Uncle Wang began to cough and regained consciousness. Later, he was taken to the hospital by ambulance where a stent was placed. He still comes to the market every day to buy groceries and always gives Aunt Zhang some fresh green vegetables grown by his own family.

Many people think that this is enough; after all, knowing how to perform first aid means having the skills needed for emergency health situations, right? Not really. Previously, when I was giving a presentation about safety measures for an internet company in Binjiang, a young administrative staff member complained to me that last year the company spent tens of thousands of yuan on purchasing a complete set of emergency kits and even organized a two-hour first aid training session. This year, however, one of the colleagues got a fish bone stuck in his throat during lunch. Dozens of people from the entire company gathered around, but all the skills they had learned—such as the Heimlich maneuver and how to apply bandages to stop bleeding—were never put to use. In the end, they had to urgently call 120 and go to the hospital to have the bone removed. She felt particularly wronged at that time, wondering why all the first-aid knowledge she had learned turned out to be completely useless when it came time to use it In essence, it equates first aid with emergency health measures—such as not swallowing rice when a fish bone gets stuck in your throat, rinsing burns with cold water for 15 minutes first, or washing a wound caused by a cat with soapy water immediately. These basic, pre-action knowledge points are inherently part of emergency health care; first aid is merely the final step taken to mitigate the consequences after a risk has occurred.

It's interesting to note that there isn't yet a fully unified view in the industry about the relative importance of the two. There is a viewpoint that believes first aid is the key to dealing with emergency health situations. If ordinary people master techniques such as cardiopulmonary resuscitation, the Heimlich maneuver, and proper bandaging for stopping bleeding, they can overcome 80% of sudden health risks that occur outside of hospitals. As a result, many cities are now promoting public education on first aid. Last alone, we gave nearly 200 lectures in communities, schools, and businesses throughout the year, and the availability of automated external defibrillators is also increasing year by year. Another perspective is more conservative; it argues that ordinary people, without systematic medical training, are likely to make mistakes if they attempt such tasks blindly. The core of emergency healthcare should still rely on a structured system. For example, many 120 emergency call centers now offer “pre-guidance” services. When you call 120, an operator will guide you step by step through the process—you don’t need to learn it in advance, and there’s no risk of making mistakes. Both approaches are currently being piloted, each with its own appropriate use cases.

According to the “Report on the Prevention and Treatment of Sudden Cardiac Death in China” released by the National Center for Cardiovascular Diseases in 2023, more than 540,000 cases of sudden cardiac death occur in China each year. The survival rate outside of hospitals is only 0.8%. In nearly 90% of these cases, no one with first-aid skills is present at the time of the incident, resulting in the loss of the critical 4-minute window for treatment. I also encountered a particularly tragic case while responding with the 120 emergency service. A young man was riding an electric bike without a helmet and was hit by a car while turning, causing him to fall onto the curb. His head hit the ground first. Kind-hearted onlookers helped him up and sit down, even asking him if he was okay. However, when he was taken to the hospital, it was discovered that he had a subdural hematoma. If he had been laid down immediately and not moved around, the bleeding wouldn’t have spread so quickly. He ended up staying in the ICU for half a month before he was out of danger. You see, this is a typical example of the problem where someone knows how to perform first aid but doesn’t understand the underlying logic of emergency health response: every step of first aid must follow the fundamental principle of “avoiding risk first, then addressing the injury,” otherwise it can actually do more harm than good.

To put it simply, emergency preparedness in healthcare is like having a comprehensive fire safety system in your home: you need to make sure not to clutter the corridors and regularly test the smoke detectors. These are proactive measures to prevent risks, and they are an integral part of emergency preparedness in healthcare； If, while cooking, the oil in the pan catches fire, you simply cover it with a fire blanket immediately – that’s first aid in action ； If the fire spreads to the living room, you will need to call 119 for professional medical assistance. You can’t just say that since you have a fire blanket at home, you don’t need to worry about smoke detectors, right? It also doesn’t make sense to think that since there are already 119 of them, buying more fire blankets would be useless, right?

Anyway, after spending five years promoting first aid knowledge, my biggest realization is that there’s no need to make the distinction between the two so clear, nor to regard emergency health as something all that fancy or high-end. When you watch short videos today, take a few extra moments to learn about the Heimlich maneuver. Tomorrow, you’ll know not to give someone who has fainted sugar water casually, or to move a person who has suffered a head injury around recklessly. When someone collapses, check their carotid artery first before calling 911. These small actions, when combined, can provide an extra layer of safety for you and those around you.