We are regularly asked what is the history of citizenAID? Where does it originate from?
The short answer is it is a progression of the concepts developed by the authors over the last 30 years, flavoured and modified by their deep clinical experience.
The reality is it’s a story. We will tell you this story here in brief as a timeline. We think you may be surprised at how many connections there are to wider developments in pre-hospital care.
The serial concepts developed by the authors since the late 1980s have become national and international standards within both civilian and military mass casualty incidents, and the foundation of treatment guidelines for the British military from point of wounding to the field hospital on all recent operations. They are what have prepared our troops throughout the Iraq and Afghanistan campaigns and contributed to the extraordinary clinical outcomes.
It is from this heritage that citizenAID has emerged. The imperative is to ensure that casualties with similar injuries in the civilian setting can receive the same opportunity for optimal outcome through early intervention by the public.
1988 – 1990: Learning from terrorism in GermanyThere is an active campaign by the IRA against the British Military in Germany. Captain Tim Hodgetts is working in the British military hospital in Hannover when there are terrorist bombs in the street where he lives, and the hospital is evacuated for bomb threats. He writes a book that contains exercises on how to prioritise multiple injured casualties, including following a bomb. Hodgetts T (1990). Self-assessment in Immediate Medical Care
1991: Lessons from the Musgrave Park Hospital Bombing2nd November 3.53pm. The IRA target the British military hospital in Belfast, placing a bomb against the fire escape door of the basement staff social club during the England vs Australia rugby World Cup Final. Captain Tim Hodgetts is in the hospital and acts as the Medical Commander for the evacuation of the destroyed hospital, rescue of the victims and their treatment in an improvised casualty clearing station. He reflects on the lessons from the disaster and records them in a medical journal article.
Hodgetts T (1991). Lessons from the Musgrave Park Hospital bombing
1992 – 1994: MIMMS course createdMajor Tim Hodgetts is a Senior Registrar in Emergency Medicine in Manchester and works with civilian Senior Registrars, Kevin Mackway-Jones and Matthew Cooke, to create the Major Incident Medical Management and Support (MIMMS) course.
The concepts of the ETHANE message, CSCATTT and the Triage Sieve are invented as part of the MIMMS course.
1994 – date: MIMMS becomes an international standardMIMMS is introduced to Australia as the first overseas location. MIMMS progressively becomes an international standard for both civilian and military audiences; it is a NATO standard from 2004. In the 2nd UK edition of the book (2002), ETHANE evolves to METHANE. The book is translated into multiple languages including Italian, Swedish, Dutch and Japanese.
The METHANE and CSCATTT concepts are repeated in a waterproof scene guide to accompany the MIMMS textbook, entitled the Major Incident Management System (Tim Hodgetts and Cris Porter, 2002).
On-line training is developed in 2009 for the field hospital that incorporates the MIMMS principles (Tim Hodgetts, Rob Russell, Andy Thurgood, Tim Davies).
Hodgetts T, Mackway-Jones K (2002, 2e). Major Incident Medical Management and Support
Hodgetts T, Porter C (2002). Major Incident Management System
1997: MIST message used for patient handover
1998 – 2008: MIMMS simplified to ACTLieutenant Colonel Tim Hodgetts simplifies the seven MIMMS principles (CSCATTT) into ‘Control then ACT’ (Assess, Communicate, Triage) and transforms Army first aid training from a theory based course to a practical course for soldiers. He writes Battlefield First Aid (1998), publishes the rationale for change (1999) and continues to direct the serial enhancements to what is renamed Battlefield Casualty Drills until 2008. A military version of the Triage Sieve is created to support BCD.
Tim Hodgetts: Battlefield First Aid — Aide Memoire. Army Code 71638.
Hodgetts T, Hanlan C, Newey C: Battlefield first aid: a simple systematic approach for every soldier. Journal of the Royal Army Medical Corps 1999; 145: 55-59.
1998 – date: Military principles applied to civilian environmentThe principles invented for the military environment are applied to the civilian environment. A version is sponsored by Rotary International to support teaching of emergency services in Goa, as part of an initiative to implement pre-hospital care across the state by the Royal College of Surgeons of Edinburgh. An enhanced version for civilian first responders is published by Tim Hodgetts and Pete Mahoney.
Hodgetts T (2004): Emergency Services First Aid Drills.
Hodgetts T, Mahoney P (2006): Emergency First Aid Drills for the First Responder.
2003 – 2009: METHANE message is adopted by the British militaryThe METHANE message is adopted by the British military and used extensively on Operation TELIC in Iraq.
2003 – 2008: Colonel Tim Hodgetts writes emergency guidelinesColonel Tim Hodgetts writes emergency guidelines immediately prior to the Iraq War, while in a field hospital in Kuwait. These become the bedrock of the first edition of Clinical Guidelines for Operations that he edits and are subsequently distributed widely to all clinical personnel in Defence in 2009 (and available unclassified on-line) as Joint Doctrine Publication 4-03.1, later renamed Joint Services Publication 999. The concepts of MIST, METHANE and CSCATTT are incorporated within JDP4-03.1.
Hodgetts T (Ed): Clinical Guidelines for Operations (2009). Joint Doctrine Publication 4-03.1
2005: Fundamental changes in first aid for combat traumaColonel Tim Hodgetts and military colleagues Pete Mahoney, Malcolm Russell and Mark Byers revolutionise the approach to first aid and reject the accepted ‘ABC’ paradigm. This is substituted by ‘<C>ABC’ and is accompanied by fundamental changes in first aid for combat trauma, including the introduction of tourniquets and topical haemostatics. There is initial strong internal resistance to change. The new theories and practices are published as journal articles and a revised training manual for Battlefield Advanced Trauma Life Support.
Hodgetts TJ, Mahoney PF, Russell MQ, Byers M. ABC to CABC: redefining the military trauma paradigm. Emergency Medicine Journal 2006; 23: 745-746.
Hodgetts T, Mahoney P. The Military Tourniquet: response. JR Army Med Corps 2007; 153: 10-15.
Hodgetts T, Mahoney P, Evans G, Brooks A (2006).
Battlefield Advanced Trauma Life Support (3e). Joint Service Publication 570.
Hodgetts T, Mahoney P, Evans G, Brooks A. Battlefield Advanced Trauma Life Support (Parts 1-3). JR Army Med Corps 2006: Suppl to volume 152; 4.
2006 – 2014: MIST message becomes NATO standardThe MIST message becomes the NATO standard during Operation HERRICK in Afghanistan. In 2007 it is modified by Tim Hodgetts to become AT MIST, on the recommendation of military helicopter doctor Simon Leigh-Smith.
2008 – date: Changes in combat casualty care provenOverwhelming evidence emerges that the changes in combat casualty care, including the first aid measures to stop bleeding, have led to many lives of seriously injured soldiers being saved.
Brodie S, Hodgetts TJ, Lambert P, McLeod J, Clasper J, Mahoney P. Tourniquet use in combat trauma: UK military experience. JR Army Med Corps 2007; 153(4): 310-313.
Penn-Barwell et al. Improved survival in UK combat casualties from Iraq and Afghanistan: 2003–2012. J Trauma Acute Care Surg 2015; 78: 1014–1020.
2012 – date: JESIP adopts the METHANE messageThe Joint Emergency Services Interoperability Programme (JESIP) adopts the METHANE message as the national standard for communication by the emergency services, and distributes this as an App.
2013: Public Basic Trauma Life Support concept createdBrigadier Tim Hodgetts and Sir Keith Porter canvas support from the Voluntary Aid Societies for a Public Basic Trauma Life Support (PBTLS) program, to raise the public standard and consistency of response for serious injury to the same level achieved for collapse from a heart attack.
2016: Creation of the citizenAID conceptThe concept of citizenAID evolves from the concept of PBTLS, focusing on response to the injury patterns seen in deliberate attacks as a pressing need to close a gap for public resilience. There is an awareness of the emerging US ‘Stop the bleed’ campaign, but citizenAID extends beyond first aid to public safety and scene organisation, and extends beyond first aid simply for bleeding. It specifically draws on military know-how and the tested principles of ‘Control then ACT’, ‘MIST’ and ‘METHANE’, creating contextualised versions for the public.
2016: SLIDE message createdConsultation is undertaken with the National Counter Terrorism Security Office, National Ambulance Resilience Unit, West Midlands Police and West Midlands Fire Service to ensure citizenAID complements existing operating procedures. METHANE is further simplified by creating the ‘SLIDE message’ for the public to meet the information needs of the Control Room operator, to avoid confusion of messages initiated by the emergency services.
2016: citizenAID website launchedcitizenAID website is launched during National Counter Terrorism Awareness Week in November, with the support of National Counter Terrorism Security Office
2017: citizenAID App is launchedcitizenAID free app is launched with widespread publicity from the BBC on 4 January 2017