13 Emergency situations: what to do first

A meta-analysis pooled 79 studies and 142,740 people. Among people whose heart stopped outside a hospital (out-of-hospital cardiac arrest), only 7.6% in total left the hospital alive. Bystander CPR was linked to a higher rate of survival to hospital discharge. After stratifying by each study's original survival rate, survival to discharge was 3.9% to 16.1% in people who received bystander CPR. These two figures come from different strata and cannot be read as a change from before to after compressions. In 53% of cases someone nearby saw the collapse, but only 32% actually received compressions from a bystander. China's BASIC-OHCA registry recorded 38,227 emergency-care cases. In 30,282 of them (79.2%) the cardiac arrest happened at home. In this group the bystander compression rate was 20.3% and 1.2% left the hospital alive. The order is: press first, then have a second person call and fetch the AED. Once the machine is on, follow its voice prompts. Whether to press depends on whether there is normal breathing. The International Red Cross 2025 first aid guidelines state that in the first few minutes after the heart has just stopped, a person may still gasp irregularly and with effort, or gasp loudly. This does not count as normal breathing. If you are not sure whether it is normal, treat it as not normal. If breathing is not normal, including gasping, irregular breathing and no breathing, start CPR at once.

The Ministry of Health’s “Technical Guidelines for Intervention in Elderly Falls” states two key points: “Falls are the leading cause of injury-related death among people aged 65 and older in China,” and “When an elderly person falls, do not rush to help them up; instead, respond according to the specific circumstances.” For those who are not fully conscious, immediately call emergency services. If they’re vomiting, turn their head to one side and clear any vomit from their mouth and nose. If breathing or heartbeat has stopped, start chest compressions at once. The guidelines also note: “If moving the person is necessary, do so gently and keep them as flat as possible.” For conscious individuals, ask whether they recall the fall; if not, it may indicate fainting or a cerebrovascular event. If they have a severe headache, a drooping mouth, trouble speaking, or weakness in the arms or legs, “lifting the older person at once may worsen cerebral hemorrhage or cerebral ischemia and make the condition worse.” If there are signs of a fracture, or back pain, or loss of bladder or bowel control, “if you have no relevant professional knowledge, do not move them casually.” In all of these cases, call the emergency number at once. If the elderly person wishes to stand up on their own, assist them slowly, then let them sit or lie down and rest while you monitor them, and leave only after you’re sure they’re alright. On the fear of being falsely blamed, this is what the law says. Article 90 of the Supreme People’s Court's Interpretation on the Application of the Civil Procedure Law has two sentences. The first: “A party must provide evidence to prove the facts on which its own claim is based...”. The second: “Before judgment is made, if a party has not provided evidence, or the evidence is not enough to prove its factual claim, the party that bears the burden of proof bears the adverse consequences.” Article 1198 of the Civil Code reads: “Where the operator or manager of a hotel, shopping mall, bank, station, airport, sports venue, entertainment venue or other business or public place, or the organizer of a mass activity, fails to meet the duty to ensure safety and causes harm to another person, it shall bear tort liability.” Article 184 of the Civil Code: “Where a person causes harm to the person helped by voluntarily carrying out an emergency rescue, the rescuer bears no civil liability.” The Supreme People’s Court has published a model case. A pharmacy operator gave CPR to a person in cardiac arrest and broke the person's ribs. The person helped was in hospital for 18 days and claimed over 9,000 yuan. The court ruled that the rescuer bears no civil liability.

Individual data from 6756 patients with acute ischemic stroke in 9 randomized trials of intravenous thrombolysis were pooled (meta-analysis). Ischemic stroke is a stroke caused by a blocked blood vessel, and intravenous thrombolysis means giving a drug to open the blocked vessel. The study looked at whether there was clear disability 3 to 6 months later (modified Rankin score 0–1). With alteplase given within 3 hours of onset, the odds ratio was 1.75, 95% CI 1.35–2.27 (confidence range). In actual percentages, it was 32.9% for those given the drug and 23.1% for the controls, a difference of 9.8 percentage points. An odds ratio is not a ratio of probabilities and must not be read as 1.75 times the chance of recovery. When treatment was delayed to 3 to 4.5 hours, the odds ratio was 1.26 (1.05–1.51). Beyond 4.5 hours it was 1.15 (0.95–1.40), and this study found no clear statistical difference. That does not mean treatment is impossible after 4.5 hours. The 2026 guideline of the American Heart Association and the American Stroke Association supports extending the thrombolysis window for some patients. Patients whose onset time is unknown, or whose onset was 4.5 to 9 hours ago, may still be suitable for thrombolysis after selection by special imaging. Whether the drug can be used is for a doctor to assess, and the earlier you get to hospital the better. The 2017 pre-hospital emergency consensus of the Emergency Medicine Branch of the Chinese Stroke Association requires emergency staff to take a suspected stroke patient “in the shortest time to the nearest accredited stroke center, or a hospital that can carry out intravenous thrombolysis and/or endovascular treatment”, and to “notify the receiving hospital in advance, before the suspected stroke patient arrives”. The consensus also states that an acute stroke patient may have impaired breathing because of “aspiration” and similar causes.

In 2014 the stroke center at the University of Kentucky in the United States reviewed the records of 736 patients with acute ischemic stroke (stroke caused by a blocked vessel). Of them, 14.1% had none of the three symptoms of facial droop, arm weakness and unclear speech (FAST) at onset. When “unsteady walking, leg weakness and visual symptoms” were also included in the screen, the share missed fell from 14.1% to 4.4%. Two hospitals in the United States went through the emergency records of 465 ischemic strokes, and 22% were missed at first. When a vessel supplying the back of the brain is blocked (posterior circulation stroke), 37% were missed at first, against only 16% for the front. People with dizziness were about 1.99 times as likely to be missed as people without (odds ratio 1.99), and people with nausea and vomiting 4.02 times. The International Red Cross 2025 first aid guidelines also list, among stroke signs, “sudden trouble seeing in one or both eyes” and “sudden difficulty walking, dizziness, loss of balance or coordination”.

The American Heart Association's 2021 scientific statement on central retinal artery occlusion (blockage of the main vessel at the back of the eye) says: “acute central retinal artery occlusion is an emergency.” Care systems should recognize it as an emergency and rank cases by urgency. The longer blood flow is cut off, the less retina can still be saved. The Oxford EXPRESS study looked at two kinds of patients: minor stroke, and cerebral ischemia whose symptoms get better on their own (medically called transient ischemic attack). These patients were later switched to same-day evaluation and same-day start of treatment. After the switch, the share with another stroke within 90 days fell from 10.3% (32/310) to 2.1% (6/281). The summary of the scientific statement also says that central retinal artery occlusion is a form of acute ischemic stroke, and a warning sign of cerebrovascular and cardiovascular events to come. The UK National Health Service (NHS) lists “blurred or lost vision in one or both eyes” as a stroke symptom, and says that even if the symptoms stop after a while you should get medical help at once. Stroke symptoms that appeared in the past 24 hours and have now stopped also need a call to the emergency number.

An eye hospital in Wuhan compared two groups of patients with acute primary angle-closure glaucoma. In the 76 days of lockdown in 2020 there were 54 patients with 64 eyes, and in the same period of 2021 there were 46 patients with 51 eyes. Both groups had similar demographic profiles. From symptom onset to treatment, the lockdown group waited 241.84±211.95 hours versus 121.53±96.12 hours for the control group (P=0.001). Their intraocular pressure at diagnosis was 52.63±12.45 mmHg versus 45.16±9.79 mmHg (P=0.001). Blindness rates were 21.87% versus 7.84%. Glaucomatous optic nerve damage was found in 20/64 eyes (31.25%) versus 7/51 eyes (13.73%) (P=0.03). A South Korean hospital reviewed 50 eyes that had experienced one acute attack and later had their lenses removed; a year later, 25 of those eyes (50%) showed varying degrees of visual field loss. The longer the time between symptom onset and pressure reduction, the higher the chance of lasting damage (P=0.005). Another prospective study had 43 people with shallow anterior chambers lie face-down in a dark room for one hour; intraocular pressure rose significantly in both eyes (P<0.01). The dominant eye saw a median increase of 3.60 mmHg, while the other eye rose 2.70 mmHg (P<0.05). The NHS states that glaucoma can sometimes come on suddenly, with symptoms of severe eye pain, a red eye, rainbow-colored rings around bright lights, blurred vision, nausea and vomiting, and headache; if these appear suddenly, call the emergency number or go to the emergency department. It is usually fluid in the eye that cannot drain, which raises the eye pressure and damages the optic nerve that connects the eye to the brain. Those at higher risk are people aged 50 or older, people whose parent, brother or sister has glaucoma, people of Asian descent, and people who are nearsighted, farsighted or have diabetes. From 2012 to 2019 the Zhongshan Ophthalmic Center treated 243 patients aged 40 or younger with angle-closure glaucoma.

Israel ran a national survey of acute coronary syndrome. The analysis covered patients with ST-segment elevation myocardial infarction, one type of heart attack. It counted the interval from arrival at the hospital until the blocked vessel was opened with a balloon (balloon dilation). With an interval of ≤55 minutes, 5/178 (2.8%) died within 30 days. With an interval of >55 minutes, 15/155 (9.7%) died within 30 days. The chest pain guideline of the UK National Institute for Health and Care Excellence (NICE) lists the symptoms that suggest acute coronary syndrome: pain in the chest, or in the arms, back or jaw, lasting more than 15 minutes; and chest pain together with nausea and vomiting, heavy sweating or shortness of breath. The International Red Cross 2025 first aid guidelines say that if the pain is severe, there is shortness of breath, or the face is pale-gray and clammy, call for emergency help at once, “even if the pain has lasted only a few minutes”. A heart attack may also hurt in the jaw, the upper abdomen, or between the two shoulder blades. Symptoms may be unclear in women, older people and people with diabetes.

The International Registry of Acute Aortic Dissection (IRAD) enrolled 464 cases from 12 centers. Aortic dissection is the disease with tearing pain in the chest and back. Of the symptoms patients reported first, the most common was sudden severe sharp pain. But the presentation varies widely, and a classic sign such as a missing pulse on one side appeared in only 15.1% of people. Total in-hospital mortality was 27.4%. For type A dissection treated with drugs alone and no surgery, mortality was 58%. The 2022 aortic disease guideline of the American Heart Association and the American College of Cardiology uses a score sheet to judge how likely a dissection is. High-risk conditions include connective tissue diseases such as Marfan syndrome, a family history of aortic disease, and a known thoracic aortic aneurysm. The high-risk kind of pain is pain in the chest, back or abdomen that comes on suddenly, is very severe, and feels like tearing. The high-risk signs are a missing pulse on one side, or a large difference in systolic pressure (the upper number) between the two arms. The guideline also states that poorly controlled blood pressure is a known risk factor for aortic rupture and dissection.

Ten Canadian emergency departments conducted a prospective cohort study on 2,131 patients with “severe headaches peaking within an hour.” They defined clear criteria upfront and tracked outcomes accordingly. Of these, 132 patients (6.2%) had subarachnoid hemorrhage, meaning a ruptured surface blood vessel in the brain. The Ottawa SAH rule includes six criteria: age 40 or older, neck pain or stiffness, witnessed loss of consciousness, onset during physical activity, sudden explosive onset of pain, and limited neck flexion on physical exam. Meeting any one of these criteria means the person must be tested. This rule identified every single patient with bleeding, with 100% sensitivity. The 95% confidence interval for this figure is 97.2%–100.0%. The trade-off is that only 15.3% of people without bleeding were excluded by this rule (specificity of 15.3%).

The Neurosurgery Branch of the Chinese Medical Association and others have published the Chinese Expert Consensus on Drug Treatment of Chronic Subdural Hematoma. A chronic subdural hematoma is a pool of blood that slowly builds up between the layers of the meninges. In professional terms it is a chronic space-occupying lesion formed by blood between the arachnoid and the dura mater. It “usually forms in the third week after head trauma” and is more common in older people. After surgery, recurrence can reach 33% and mortality can reach 32%. In patients aged 90 or older, only 24% recover well overall. A systematic review: worldwide there are 3.39 to 39.1 new cases per 100,000 people per year, rising with age, up to three times as high over age 80. The most common causes are injury and falls, followed by long-term heavy drinking, the use of drugs that prevent blood clotting (anticoagulants), and violent injury. A geriatrics review: the clinical picture “typically includes confusion, cognitive decline, gait disturbance or drowsiness, and may resemble other geriatric syndromes”. The same review says the rising incidence is linked to more people taking anticoagulants and antiplatelet drugs (such as aspirin and clopidogrel), and to older people falling more easily. Another literature review states that there is a gap between the injury and the symptoms, and the injury is usually very slight, so it is often overlooked. More than 50% of patients deny having been injured.

The International Cooperative Registry on Pulmonary Embolism (ICOPER) gathered data from 2,454 patients with confirmed acute pulmonary embolism treated at 52 hospitals across seven countries. Pulmonary embolism occurs when a blood clot blocks a pulmonary artery. Within three months, the overall mortality rate for these patients — regardless of cause — was 17.4% (426 out of 2,454). The WHO WRIGHT project found that travel lasting four or more continuous hours “roughly doubles” the risk of blood clots forming in veins and traveling to the lungs (venous thromboembolism). But the chance for any one person is still low: sitting still for 4 hours or more is “about one in six thousand”. The NHS advises that on a plane, train or car trip of 4 hours or more you wear loose clothing, drink plenty of water, do not drink alcohol, and get up and walk if you can. In 2021 Cochrane pooled 12 randomized trials in which the passengers were on flights of more than 5 hours. Among people who wore graduated compression stockings, deep vein thrombosis with no symptoms, found only by testing, was about 90% less: OR 0.10, 95% CI 0.04 to 0.25 (confidence range). Of 2637 people, 50 were found to have it: 3 who wore stockings and 47 who did not. In these trials nobody died, got a pulmonary embolism or had a clot with symptoms. So whether stockings prevent these truly bad outcomes cannot yet be worked out.

Over six years, 11 Level I trauma centers in Texas treated 1,026 patients with limb vascular injuries; 181 of them (17.6%) had a tourniquet applied prior to arrival. Unadjusted mortality rates were 3.9% for those with a tourniquet and 5.2% for those without. After adjusting for other factors, tourniquet use was still independently linked to survival; the adjusted odds ratio was 5.86, with a 95% confidence interval ranging from 1.41 to 24.47. Among 232 casualties at a Baghdad field hospital, 90% of those who received a tourniquet before shock survived, versus just 10% who got one after shock occurred; all five patients needing a tourniquet but not receiving one perished, while 87% of those with a tourniquet survived. The recommended sequence is: direct pressure, and clothing or a towel will do → if bleeding on a limb persists, apply a tourniquet → call 120 → never loosen it.

According to the 2023 guidelines issued by China’s National Disease Control and Prevention Administration and Health Commission, “The fatality rate from rabies is practically 100%.” Recommended first aid is “to thoroughly rinse all bite and scratch sites with alternating streams of soap (or another mildly alkaline cleanser) and running water under adequate pressure for roughly 15 minutes.” Light bites on bare skin and scratches without bleeding are category II exposures and need vaccination. Category III exposures, involving penetrating wounds or licked broken skin, mandate both wound treatment, passive immunization, and full vaccination. The WHO reports that roughly 59,000 people worldwide die from rabies each year, 99% of them transmitted by dogs.

In Australia, 2495 children with burns and scalds were followed. In children whose burn was rinsed with cool running water for 20 minutes within 3 hours of the injury, the odds ratio for later needing a skin graft was 0.6, 95% CI 0.4–0.8 (confidence range). This means a lower chance of needing a graft, but it cannot be read directly as only a 60% chance of a graft. The pooled result of 7 studies likewise found that “20 minutes of cool running water within three hours of the injury significantly lowered the chance of needing a skin graft and surgical wound treatment”. The International Red Cross 2025 first aid guidelines state that you should not rinse with ice water or apply ice, because it makes the damage worse. The NHS states that clothing and jewelry near the burn should be taken off, but anything stuck to the wound should be left alone, and no ointment, oil or butter should be put on the burn.

Epinephrine is the drug of first choice (first-line) for anaphylaxis of grade 2 and above, and the guideline gives it a strong recommendation. Antihistamines and steroids act slowly and cannot take its place. The International Red Cross 2025 first aid guidelines state that an epinephrine auto-injector can be used through clothing, as long as the clothing is not thick. Where a doctor has prescribed it and local law allows, a bystander may help to inject it when the patient cannot do so themselves.

This avoids tooth and jaw injury from prying the mouth open or pushing in a hard object. It avoids fractures from forcibly holding the person down. A seizure that does not stop after 5 minutes is the red line for calling an ambulance. A convulsion during a fever in a child is called a febrile seizure. The UK National Health Service (NHS) says it is most common in children from 6 months to 6 years. It usually lasts 2 to 3 minutes and rarely longer than 10 minutes, and generally does not harm the child or leave lasting effects. The NHS lists several situations in which to call the emergency number: the first seizure, a seizure of more than 5 minutes, difficulty breathing, and convulsions on one side of the body only. Also: being sleepier than usual for more than 1 hour after it stops, and more than one seizure within 24 hours. The American Academy of Pediatrics 2011 guideline says that for a simple febrile seizure in a child of 6 to 60 months, an EEG, blood tests or brain imaging are generally not needed. The doctor mainly looks for the cause of the fever. The NHS also warns not to try to bring a child's temperature down by undressing them or sponging them with cold water.

A blood sugar level below 3.0 mmol/L qualifies as clinically meaningful hypoglycemia. If a person shows changes in consciousness or movement that require outside assistance to manage, this is severe hypoglycemia that can be deadly.

This approach prevents rescuers from getting electrocuted as well, avoiding a situation where one victim becomes two. For victims who are not breathing normally after being freed from the electrical current, give CPR following item 1 of this section (press hard on the chest). The emergency response guidelines from the US Centers for Disease Control and Prevention advise: first look, do not touch, because the person may still be live. If possible, cut the power first. If that’s not feasible, use non-conductive materials like cardboard, plastic or wood to move the power source away. If breathing or pulse has stopped after the person is freed from the current, start CPR at once. A review of relevant studies found that patients who suffer cardiac arrest due to electrocution and are successfully revived often have a good prognosis.

According to China’s disease surveillance system, 11,523 people died from carbon monoxide poisoning in 2018. The highest numbers were recorded in January (2,845 cases), February (2,321 cases), and December (2,010 cases). During those three winter months, 66% to 73% of all deaths happened at home. These are the numbers reported into the system, not estimates scaled to the national population. In the United States, over 400 people die each year from accidental carbon monoxide poisoning unrelated to fires; more than 100,000 people go to an emergency department, and more than 14,000 are hospitalized. The US Centers for Disease Control and Prevention says carbon monoxide poisoning is often described as “like the flu”. The NHS states that symptoms get worse while you stay in the room with the fault, and get better when you leave or go outdoors.

The handling guidance from the Institute for Occupational Health and Poison Control of the Chinese CDC has four cases. Taken by mouth (digestive tract): at once drink a suitable amount of milk or egg white, and “remember, do not induce vomiting”. Get medical care as soon as possible and take the packaging or the instructions along, “so that the doctor can quickly judge the ingredients and decide the treatment plan”. Breathed in (respiratory tract): move at once to a well-ventilated area and loosen the collar to keep the airway clear. If there is severe coughing, shortness of breath or difficulty breathing, get medical care at once. Skin contact: at once rinse the area with plenty of clean water for at least 15 minutes, taking care that the rinse water does not splash the eyes or other unbroken skin. Eye contact: at once rinse the eyes with plenty of clean water or saline for at least 15 minutes. Hold the eyelids open while rinsing so that the water reaches the eyeball and the inside of the lids, and “never rub the eyes”. After rinsing, go to an eye department at once. High-risk products are recognized by acidity (pH). Those with pH below 3 are toilet cleaners, descalers, floor cleaners and stainless steel polish. Some strong drain cleaners also contain dilute sulfuric acid. Those with pH above 11 are drain cleaners, strong kitchen degreasers, dishwasher powder, oxygen bleach powder and scouring powder. There is also a combination that causes harm on the spot: disinfectant used together with a toilet cleaner containing hydrochloric acid produces chlorine gas. Chlorine gas irritates the airway, causes severe coughing and shortness of breath, and can even threaten life. Not inducing vomiting applies to more than cleaners. The NHS poisoning page lists medicines, cleaning products, some plants and mushrooms, and pesticides as common causes of poisoning, and states that if you suspect someone has swallowed something harmful, do not make them vomit, because they “may choke or stop breathing”, and do not give them anything to eat or drink. If the person has vomited, keep a little of the vomit to show the doctor. The International Red Cross 2025 first aid guidelines state not to make a person who swallowed a poison vomit, because it “may injure the throat”. Hand the bottle, packaging and label to the emergency staff.

Three steps on the spot. First, at once take off contaminated clothing, shoes and socks: the poison keeps being absorbed through the skin, and the parts held against the skin by clothing are injured worst. Second, rinse with plenty of running water. The lower limit given by the Institute for Occupational Health and Poison Control of the Chinese CDC is “at least 15 minutes” each for skin and eyes. The Hunan Provincial Emergency Management Department gives 20 to 30 minutes of rinsing for the wound, and “longer for strong chemicals”. Take the longer of the two. Third, for the eyes, “hold the eyelids open so that the water reaches the eyeball and the inside of the lids”, “never rub the eyes”, and go to an eye department at once after rinsing. Use room-temperature or slightly warm water; hot water is forbidden. Do not put ointment, red antiseptic solution or anything else on a fresh wound, and do not wrap it in dirty cloth; anything applied affects the doctor’s judgment of how deep it is. Legally, “chemical skin burns” and “chemical eye burns” are both on the statutory list of occupational diseases, and those that happen at work are handled as occupational disease and work injury. In an acute occupational hazard accident, the employer “shall promptly organize treatment, health checks and medical observation, and the employer bears the costs” (nationwide).

The US National Weather Service: heatstroke is a “serious medical emergency”. Signs are a body temperature above 103°F (39.4°C), confusion, slurred speech, and hot, red skin. The response is to call emergency help at once, move the person to a cool place, cool them with cool water and wet cloths, and “do not give fluids”. Heat exhaustion shows as heavy sweating, weakness, cool and clammy skin, and a fast, weak pulse; the response is to move to a cool place, loosen clothing and sip water. Get medical care if there is vomiting, if it gets worse, or if it does not ease within 1 hour. The Yunnan Provincial Center for Disease Control advises: move at once to a cool, ventilated place, cool with cold wet towels, give a salted drink to a person who is awake, and call the emergency number at once for severe symptoms. It also says severe heatstroke has an “extremely high death rate”. The Chinese Center for Disease Control and Prevention advises: cool first, transport later, and cool within the “golden half hour” after the patient loses consciousness. Where possible, healthy young and middle-aged adults with no underlying disease can be cooled quickly by immersion in cold water, and older people and those with underlying disease are sprayed with water and cooled by evaporation. The Wilderness Medical Society's heat illness guideline, updated in 2024, says cold water immersion is the most important treatment for severe heatstroke and cools fastest. If there is no ice water, use the coolest water at hand; if immersion is not possible, spraying water and fanning works at about half the speed of immersion. The US National Institute for Occupational Safety and Health (NIOSH) says that in heatstroke the body temperature can rise to 106°F (about 41 °C) or higher within 10 to 15 minutes. Among the symptoms it lists are “hot, dry skin, or profuse sweating”. The 2014 Chinese CDC heatstroke guide lists for heatstroke “skin that is red, hot and dry with no sweat”, and requires “do not give the patient water”; if the patient vomits, turn them onto their side to keep the airway clear.

The Chinese CDC published the “Guidelines on Prevention and Emergency Treatment of Heatstroke (2014),” which states: “Consume at least 2–4 cups of cool water per hour (500–1000 ml), ensuring the temperature is not excessively high; drinking should be done in small amounts at frequent intervals.” It also advises: “Avoid beverages containing alcohol or large amounts of sugar, as these lead to further fluid loss. Do not consume overly cold drinks.” For heatstroke specifically, the guidelines explicitly warn: “Do not give the patient any water to drink.” NIOSH in the U.S. recommends encouraging “small, frequent sips of cool water” for heat exhaustion, and for heat cramps, suggests sports drinks with sugar and electrolytes every 15–20 minutes — “do not use salt tablets.”

FEMA’s fire escape text: “Drop to the ground and crawl under smoke toward an exit.” It also advises testing door handles and surfaces first — “If they’re hot, or smoke is coming through the crack, don’t open the door; use the other exit instead.” Open doors slowly, and close them at once if heavy smoke appears. For clothing fires, the same advice applies: “Stop, lie down, roll, and shield your face.” If escape proves impossible, close the door and seal any gaps or vents with cloth or tape, then call for help and state your location. China’s emergency management department shares these same recommendations: never use elevators, head downward if the fire is small, cover your nose and mouth with a wet towel or mask, and evacuate while staying low to the ground.

WHO: about 300,000 people drown worldwide each year, 92% of them in low- and middle-income countries. Drowning is the fourth leading cause of death for children aged 1 to 4 and the third for children aged 5 to 14. The intervention WHO recommends is “safe rescue and resuscitation training”, for example first learning rescues that do not need you to enter the water. First shout for others and call 110/120, then pass a long pole or rope from the bank, or throw a floating object such as a life ring or an empty drum. The International Red Cross 2025 first aid guidelines state that the rescuer should stay out of the water if at all possible: hold out something rigid (such as a pole or a branch) from the bank or from a boat, or throw a rope or something that floats. The rescuer should not touch a drowning person who is struggling, because of the danger of being pulled into the water. Someone who is already in the water must know the water conditions and bring something that floats. If the person is pulled out with no response and is not breathing normally, start CPR at once. The 2024 drowning resuscitation guideline of the American Heart Association and the American Academy of Pediatrics stresses that cardiac arrest from drowning is usually caused by severe lack of oxygen. A trained rescuer should give rescue breaths together with chest compressions. If you do not know how, cannot, or are unwilling to give rescue breaths, keep up chest compressions until rescuers arrive. When you call the emergency number, put it on speaker and follow the dispatcher's guidance.

The original text from the US National Library of Medicine: first ask “Are you choking? Can you speak?”. “Do not step in if the person can cough forcefully or speak”, because coughing by itself can usually bring the object up. If they cannot speak, “repeat 5 back blows followed by 5 abdominal thrusts until the object comes out or the person becomes unresponsive”. “If unresponsive, start CPR”, and have someone call the emergency number at the same time. For pregnant women and people with obesity, give chest thrusts instead. The International Red Cross 2025 first aid guidelines state not to reach into the mouth blindly with a finger, which may push the object deeper; only a solid object you can see should be taken out with a finger.

The National Park Service’s Mojave Desert page lists three key statements: “Each person needs at least 1 gallon (roughly 3.8 liters) of water daily; hikers and cyclists require 2 gallons per day.” “Tell someone about your planned route, destination, return date, vehicle type, and license plate number.” “Cell service is intermittent.” Death Valley’s guidance advises: “Avoid hiking in the valley floor or at low elevations during peak heat,” while wilderness areas have “virtually no cell coverage”, and it recommends bringing a satellite phone. The Mojave driving guide explicitly states: “In an emergency, staying next to your vehicle is the single most important action you can take.” It also notes that such incidents are rare, yet some people still perish from heat exposure or cold after attempting to walk back to a road. These recommendations are organized into five priority steps: first, report that you are safe and give your coordinates, and if you have a signal send your location first and then make a call; second, shield yourself from the sun and retain body heat; third, save water; fourth, avoid wandering off; fifth, attempt to signal for help. The Chongqing Emergency Management Bureau adds that three fire piles arranged in a triangle constitute an internationally recognized distress signal; if rescuers are nearby, shout “three short bursts, three long bursts, then three short bursts” and repeat every minute. On sunny days, shiny things such as mirrors or can lids can reflect the light. Meanwhile, China’s Ministry of Culture and Tourism reminds self-driving tourists to be cautious about going into uninhabited areas, to travel with several vehicles where possible, and to rent a satellite phone if necessary.

According to the U.S. National Weather Service, any body temperature below 95°F (35°C) indicates hypothermia, and symptoms such as feeling cold, sluggishness, and confusion warrant immediate medical attention. The response is to “get medical help at once, move the person to a heated room, and rewarm from the center of the body first”, and to give hot drinks. Alcohol is discouraged because it reduces shivering. “Do CPR if the person loses consciousness”; for how to judge whether to press, see item 1 in this section (not breathing normally). Warm water or body heat can be used to treat frostbite, but avoid hot water or direct radiant heat sources like fireplaces. The Wilderness Medical Society’s 2019 hypothermia guidelines are the practice guideline in this field.

The WHO text has three sentences: “Immobilize the bitten body part completely and get to the nearest health facility quickly.” “Avoid using tourniquets and avoid cutting the wound.” “Treat with appropriate antivenom against the local snake species.” “Quality antivenom is the most effective treatment for preventing or reversing most of the toxic effects of snakebite.” About 81,000 to 138,000 people die of snakebite worldwide each year, and the number who suffer amputation or permanent disability is about 3 times the number of deaths. China's 2024 snakebite treatment guideline estimates 250,000 to 280,000 venomous snakebites a year in China. Most of those bitten are 50 or older. Hospitals in the Yangtze River basin and 11 southern provinces treated 40,817 snakebite patients from 2017 to 2021. 23 (0.06%) died in hospital. The International Red Cross 2025 first aid guidelines state: the bitten person should move as little as possible, and if the bite is on the leg, should not walk. Take off jewelry, watches and tight clothing so that swelling does not cut off the blood flow. Do not use a tourniquet, do not suck, do not apply cold, do not rub, and do not cut with a knife; these do not work and may do more harm. If you can safely take a photo of the snake, do; do not try to catch or kill it.

The China Earthquake Administration’s educational video “Earthquake: Hide or Run?” promotes the rule “Take shelter nearby during the quake, then evacuate quickly afterward,” but explicitly limits this advice to “buildings that meet seismic safety standards.” The reasoning is that such structures “are less likely to collapse as a whole.” The video also notes that “falling building components and decorative items” pose the greatest threat to life safety, while “running around without any protection during a quake” increases the risk of being struck by falling ceilings, chandeliers, or other objects. Recommended actions include “using hands or soft objects to shield the head and neck” and “gripping table legs tightly”; if no table is available, “crouch close to load-bearing walls and stay away from exterior walls, windows, and balconies.” For those outdoors, the advice is “move at once to an open place to shelter from the quake.” Conversely, during the 1988 Armenian earthquake, Soviet-era prefabricated panel buildings collapsed en masse. A case-control study conducted after that disaster concluded that “leaving a building right after the first tremor is a protective behavior.” People who stayed indoors were 4.40 times as likely to be injured as those who ran out (odds ratio 4.40), 95% CI 2.24–8.71 (confidence range). The odds of injury indoors were 12.20 times higher than outdoors (3.62–63.79), and in buildings above five stories it was 3.65 times that in lower buildings (2.12–6.33). The Ministry of Emergency Management's earthquake guidance states: “people living in old brick-and-concrete buildings should look more actively for a chance to evacuate quickly.” For people in single-story houses, “if you are by a door or window and there is no other dangerous building outside the window, you can run at once to the open ground in the middle of the yard.” In an earthquake “never use an elevator”; on the first or second floor “do not choose to jump out of the building either”; in a high-rise “take care not to go downstairs”. Once outdoors, keep away from buildings with glass curtain walls, overpasses, utility poles, street lamps and billboards.

The original guidelines issued by the U.S. National Park Service on bear encounters contain six key points: “Do not run — bears can sprint uphill or downhill just as fast as racehorses.” “Stay calm; most bears have no interest in attacking and simply want to be left alone.” “Keep speaking to the bear in a low, steady voice.” “When the bear stops moving, turn sideways and back away slowly so you can keep watching it without tripping.” “Make yourself appear as large as possible.” “Do not climb trees — both grizzly bears and black bears are capable climbers.” In the event of a brown bear attack, “lie down and play dead, placing hands behind the neck and legs apart.” For black bear attacks, “do not play dead; run toward a vehicle or building, and if escape is impossible, fight back using any available object.” Dog bites should be treated according to item 13.

There is no safe place outdoors within range of a thunderstorm. It is safe only 30 minutes after the last thunder. The US National Weather Service states: run into a sturdy building or a hard-topped vehicle. A tent gives no protection at all from lightning, and an open-sided picnic shelter is not safe either. Cave mouths and small rock overhangs are also dangerous, because the arc can jump across gaps. Taking shelter under a tree is the second-largest cause of lightning casualties. If you can hear thunder, you are most likely already within lightning range: “when thunder roars, go indoors”.

Sleeping at 2450 meters or higher carries a risk of altitude illness. High-altitude cerebral edema and pulmonary edema (fluid in the brain and the lungs) are fatal if you do not descend in time. The US CDC Yellow Book gives three rules for preventing severe illness: know the early symptoms and be willing to admit them; with symptoms, however mild, do not go to sleep any higher; and if symptoms keep getting worse after rest or treatment at the same altitude, descend. Acute altitude illness usually improves quickly after descending 300 meters or more. For high-altitude cerebral edema in a remote area, descend at once, and use dexamethasone and oxygen together if you have them. For high-altitude pulmonary edema, in most cases you must descend at once, and descent and oxygen are both far more effective than drugs.

Applying oil, burning it, or twisting as you pull provokes the tick to squeeze fluid carrying pathogens into the skin. Those actions also raise the risk of leaving its mouthparts stuck inside. In China, tick-borne severe fever with thrombocytopenia syndrome led to 6,602 reported cases and 306 deaths in 2024 — the highest totals on record. From 2010 through 2024, the average fatality rate stood at 4.79%, rising with age; for those aged 85 or older it reached 9.15%.

All microorganisms that can cause disease through drinking water are killed (inactivated) within seconds at the temperature of boiling water. “Water at high altitude is not hot enough” is a common misunderstanding. The same page states that the other two methods each have a gap: most portable filters do not stop viruses; chlorine and iodine at practical doses barely kill a parasite such as Cryptosporidium. Where people and animals are active, even surface water that looks clear needs protection against all enteric pathogens, including Cryptosporidium. In remote wild water, the main concern is Giardia and enteric bacteria.

Life is worth more than money, and the other person is risking a serious crime for a few hundred yuan. Article 263 of the Criminal Law provides that robbing public or private property by violence, coercion or other means is punished with imprisonment of not less than three and not more than ten years and a fine. With a firearm, entering a home, causing serious injury or death and the like, the sentence is ten years or more, up to death. The lawful defense in Article 20 of the Criminal Law protects “stopping an unlawful infringement that is under way”. The 2020 guiding opinion of the Supreme People's Court, the Supreme People's Procuratorate and the Ministry of Public Security states that even though the property has already been taken, if it can be recovered by chasing or intercepting, the infringement can be treated as still going on. Whether it counts as lawful defense also depends on the situation at the time and the purpose of stopping the infringement. A finding of excessive defense requires both that the necessary limit is clearly exceeded and that major harm is caused. It cannot be held that the defense has ended merely because the other person took the money and turned away. For your own safety, do not risk fighting or chasing for money. After you get away, note at once their build and looks, accent, license plate and direction of escape, and call 110.

Article 292 of the Criminal Law states: “Those who lead or actively take part in group brawls shall be sentenced to up to three years in prison, criminal detention, or surveillance.” If the brawls happen repeatedly, involve large numbers on a large scale with a bad social impact, cause serious social disorder in a public place or on a main road, or involve weapons, the punishment rises to three to ten years. If such fights cause serious injury or death, perpetrators are charged under laws on intentional injury or homicide. The Public Security Administration Punishment Law also sets penalties: assaulting others brings a detention of five to ten days plus fines of 500 to 1,000 yuan. Group fights handled as hooliganism can lead to up to fifteen days in jail and fines up to 2,000 yuan. Article 5 of the “Opinions on Properly Applying Self-Defence” says unlawful attacks include those aimed at you, those endangering the state or the public interest, and those aimed at others. Article 9 adds that if one side starts the fight with excessive force, or continues attacking even after the other side tries to avoid conflict, the responding party is usually considered acting in self-defence.

The HIV-prevention public education column of the Beijing Municipal People's Government says that medication taken to prevent infection after contact is called post-exposure prophylaxis (abbreviated PEP), and should be started “as soon as possible, within 2 hours if possible, best within 24 hours, and not later than 72 hours”. It must also be “taken continuously for 28 days”. Beyond 72 hours, starting is no longer recommended; this is a hard time limit. The same Beijing article states that “taking it regularly every day blocks better than often missing doses”. The technical guideline of the Chinese CDC National Center for AIDS/STD Control and Prevention states that missed doses and stopping on your own both lower the preventive effect. The guideline requires follow-up at week 2 after starting the drug to check for side effects, and an HIV antibody test and a hepatitis C antibody test at 30 days and again at 90 days after exposure. The Chongqing Municipal CDC announced in 2024 that across the city, 29 clinics in 26 districts and counties can prescribe pre-exposure and post-exposure preventive drugs, and 14 of them offer 24-hour service.

Article 183 of the Civil Code: “Where a person suffers harm from protecting the civil rights and interests of another, the tortfeasor bears civil liability, and the beneficiary may give appropriate compensation. Where there is no tortfeasor, the tortfeasor has fled or cannot bear civil liability, and the injured person asks for compensation, the beneficiary shall give appropriate compensation.” State Council General Office Document No. 39 [2012] says what to do for people hurt in acts of bravery. Medical institutions are to set up a green channel and “keep to the principle of ‘treat first, charge afterward’”. On medical costs, the original reads: “Medical costs arising from emergency treatment are borne by the wrongdoer or the responsible person where there is one; where there is no wrongdoer or responsible person, or the wrongdoer or responsible person has fled or cannot pay, they are settled through the basic medical security system as provided.” For a death: “where the conditions for being assessed as a martyr are met, the person is assessed as a martyr according to law”; “where it is treated as a work injury, the family receives the one-time work-death subsidy and a special survivors' allowance equal to 40 months of the person's wages”. For disability: “where the conditions for work injury insurance benefits are met, the corresponding benefits are carried out under the Regulations on Work Injury Insurance; where they are not met, the civil affairs department assesses the disability grade and carries out the corresponding benefits”. On employment, “priority is given to employment assistance, with key support”, and public-welfare posts are “arranged first for eligible people who acted bravely”. On housing, “priority is given in the housing security system, in renting or selling affordable housing first or giving a housing rent subsidy”.

The 2025 International First Aid Guidelines from the International Federation of Red Cross and Red Crescent Societies state: “First aiders should apply pressure around any foreign object (such as a knife) that has penetrated the body and keep it stable; do not remove it.” “Never pull any object out of abdominal or chest wounds – doing so can cause severe bleeding and makes it harder to assess the injury.” “Foreign objects embedded in the body should be kept stable; if one moves with the pulse, let it move and just steady it loosely.” “First aiders must not push protruding organs back into the body.” For open chest wounds without active bleeding, “it is acceptable to leave them uncovered, as sealing them may trap air in the chest cavity and cause partial or total lung collapse (pneumothorax).” For all penetrating chest or abdominal wounds, call for emergency help at once.

The International Federation of Red Cross and Red Crescent Societies released its 2025 International First Aid Guidelines, which state that “any injury to a limb should be treated as a possible fracture” and “the only reliable way to confirm a fracture is an X-ray; when in doubt, treat it as a fracture.” The purpose of immobilisation is “to minimise movement and pain.” Cold application “should be limited to 20 minutes at a time to reduce pain; longer exposure can damage the skin.” “For long bones such as the femur, bleeding from the bone itself can be life-threatening.” Call emergency services if there is significant pain or swelling, signs of shock, a suspected femoral fracture, or obvious deformity of the limb. For a fracture bent at an angle, realigning it on site is considered only when two conditions both hold: first, when help is far away (or resources are limited) and the part of the limb below the angle appears cold and pale, or when the rescuer cannot safely immobilise it for transport; second, the rescuer has been trained. For open fractures, the priority is stopping bleeding and preventing infection. But a first X-ray that shows nothing does not mean there is no fracture. The guideline on hip fracture from the UK National Institute for Health and Care Excellence (NICE) says: if the X-ray is normal but a hip fracture is still suspected, “do an MRI”; if that cannot be done within 24 hours, consider a CT. Its fracture guideline says: for a suspected wrist scaphoid fracture, “after careful physical examination, consider an MRI first”. The scaphoid is a small bone in the wrist. A Cochrane review states: “initial X-rays cannot exclude a fracture”. In the studies it included, among people whose X-rays were normal but whose doctors still suspected a scaphoid fracture, the median share with a real fracture was 20%. The American College of Radiology has an appropriateness standard for knee trauma. It says: when the X-ray shows no fracture but an occult fracture or internal joint injury is still suspected, MRI as the next step is “usually appropriate”. It also says MRI is highly accurate for occult fractures and for meniscal and ligament injuries.

A prosecutor of the Beijing Municipal People’s Procuratorate says: “Whether minors or adults, anyone who experiences sexual assault should call 110 immediately.” Prompt reporting and medical care “allow investigators to examine the scene, collect physical evidence, and preserve proof in a timely manner.” A People’s Daily sexual assault prevention handbook, reprinted by the Guizhou Provincial Department of Civil Affairs, advises: “If sexual assault occurs, preserving evidence is the top priority.” It recommends keeping “body fluids, hair, skin cells, and communication records” and warns that “after an assault, one must not shower, wash clothes, tidy the room, or throw anything away.” In cases involving acquaintances, preserving call logs and messages is essential; any threats or attempts at bribery by the perpetrator must also be documented. The Xicheng District Procuratorate in Beijing adds: “Try not to shower before undergoing a physical examination.” WHO notes that emergency contraception may be used “when a woman has been sexually assaulted without effective contraceptive protection,” and recommends using it within 5 days; the earlier, the more effective. Emergency contraceptive pills containing levonorgestrel have a pregnancy rate of 1.2% to 2.1% among users; in China, such pills are sold over the counter. According to the Wuhan Health Commission, after unprotected sex, “within 72 hours, the earlier the pill is taken, the better it prevents pregnancy.” HIV blocking drugs should be taken within 2 hours if possible, and no later than 72 hours (nationwide).

The American Heart Association and American Academy of Pediatrics issued 2025 pediatric basic life support guidance. It states that choking (for example, an object blocking the airway) “is a leading cause of death in infants and children.” Liquids are what infants most often aspirate. Mild obstruction: still coughing or making sounds — let the child cough while you monitor for worsening. Severe obstruction: weak cough or none, cannot cry, cyanosis — call emergency services first, then “repeat cycles of 5 back blows and 5 chest thrusts until the object is expelled or the infant becomes unresponsive.” Abdominal thrusts are not recommended for infants because they can injure internal organs. Chest thrusts are now taught with the heel of one hand because it achieves greater depth than the old two-finger method. When the infant is unresponsive, start CPR with compressions first; do not check a pulse. Remove only visible objects before giving breaths. The guideline explicitly says “do not perform blind finger sweeps.” The International Federation of Red Cross and Red Crescent Societies 2025 international first-aid guidance uses the same sequence: up to 5 firm back blows between the shoulder blades, then turn the infant and give up to 5 chest thrusts, then call emergency services if needed. Its chest-thrust technique uses a two-thumb encircling grip. The Fujian Provincial Red Cross emergency-care training center describes “5 back blows + 5 chest thrusts” for infants under 1 year: hold the infant prone on the forearm with the head lower than the trunk for back blows.

The American Heart Association and American Academy of Pediatrics 2025 pediatric basic life support guideline states that respiratory problems remain the main cause of cardiac arrest in infants and children. Among infants with out-of-hospital cardiac arrest, only 6.6% survive to hospital discharge. For a lay person who finds an unresponsive infant or child with abnormal breathing and no signs of life, “CPR should be started immediately” without checking a pulse. Compression depth is at least one-third of the anteroposterior chest diameter; for infants, “about 1.5 inches (4 cm).” Rate 100 to 120 per minute. One rescuer: 30 compressions then 2 breaths. Two rescuers: 15 compressions then 2 breaths. Use one-hand heel or two-thumb encircling compressions; if encircling is not possible, use heel of one hand. Two-finger compression has been removed because depth was inadequate. The guideline also states that for out-of-hospital pediatric cardiac arrest, adding ventilations to compressions improves survival. A U.S. registry of 3,900 children 18 or younger with out-of-hospital cardiac arrest found 59.4% were infants. Bystander CPR was associated with an adjusted hospital discharge survival of 13.2% versus 9.5% without CPR; adjusted OR 1.57 (about 57% higher odds of survival), 95% CI 1.25–1.96. Among infants, CPR with breaths was linked to higher survival and better neurological recovery; compression-only outcomes were similar to no CPR. IFRC 2025 guidance: check responsiveness by picking up the infant or flicking the foot. If alone, call emergency services on speakerphone. If no phone allows simultaneous calling, perform 1 minute of CPR before calling. A popular-science article from the Capital Institute of Pediatrics, republished by the Beijing Municipal Health Commission, states: “If only 1 person is present, perform 2 minutes of CPR before calling 120.” Compression depth “4 cm for infants.” Mouth-to-mouth-nose for breaths under 1 year.

Figures from the US poison database for 1985 to 2009 show that the share of children left with serious injury or death after swallowing a button battery rose 6.7-fold. The most dangerous is the 20 mm lithium battery. In children 4 or younger, and with lithium batteries 20 mm or larger in diameter, the outcomes were clearly worse. A battery stuck in the esophagus needs only 2 to 2.5 hours to cause a serious injury that leaves lasting damage. In 92% of the deaths and 56% of the serious injuries, nobody saw the child swallow it. At least 54% of the deaths and 27% of the serious injuries were first misdiagnosed, because the symptoms were not typical. After the battery has been removed, the injury can still go deeper. Esophageal perforation, a hole between the esophagus and the trachea or a large vessel, and major bleeding have all appeared several days later. In another analysis of 8648 cases, 61.8% of the batteries swallowed by children 6 or younger had been taken straight out of an appliance. The guideline of the US National Poison Control Center says that if you suspect a battery was swallowed, “do not induce vomiting”. A battery stuck in the esophagus “can cause a severe burn in as little as 2 hours”, and “do not wait for symptoms”. For children 12 or younger, get an X-ray at once to find the battery. Product injury surveillance by the Guangdong CDC shows nearly a hundred injuries linked to swallowing batteries in the past five years, most of them button batteries. Of the injured, 92.9% were children aged 0 to 6. Moderate or severe injury made up 39.3%, and 25.0% needed to be admitted to hospital. Its advice is “get medical care at once; do not induce vomiting or feed the child yourself”. The same surveillance states that when Buckyballs (magnetic beads) are swallowed, beads in neighboring loops of bowel “attract and squeeze the bowel, causing bowel obstruction or perforation”, and when a swallow is suspected, “take the child for medical care at once”. A 2025 literature review included 130 children who all had a connection between loops of bowel (enteric fistula) after swallowing 2 or more magnets. The median age was 3.3 years, 95.5% needed surgery, 19% had complications after surgery, and 1 of them died.

The UK National Health Service (NHS) lists these signs of alcohol poisoning: confusion, slurred speech, unable to stand, vomiting, loss of bladder or bowel control, pale or bluish skin, slow or irregular breathing, seizures, and cannot be woken. If you think someone has alcohol poisoning, or they have a seizure, lose consciousness or stop breathing, call the emergency number. What to do is stay with them, “because they may choke on their own vomit or stop breathing”. If they are awake, help them sit up. If they have passed out, put them in the recovery position on their side and watch whether their breathing is normal. If they are still alert, able to swallow and not vomiting, they can take small sips of water. Keep them warm with a coat or blanket. There are five things not to do. Do not let them drink more alcohol. Do not give them food, which they may choke on. Do not give coffee or drinks with caffeine, which make dehydration worse. Do not let them take a cold shower or soak in cold water, which may chill them, make them fall, or make them pass out in the water. Do not try to make them vomit. An article by an emergency doctor on the website of the Shaanxi Provincial Health Commission says that the throat reflex of a drunk person is weak, so vomit is easily drawn into the windpipe, and in serious cases the person dies “directly of suffocation”. Emergency departments often receive drunk people who are already dead, with large amounts of vomit suctioned from the windpipe. In the stage of stupor, if the face is pale, the lips are bluish-purple, the skin is cold and clammy, the body temperature drops and breathing is shallow, call 120. At that point let them lie on their side, “do not induce vomiting or feed them”, cover them with a blanket to keep warm, and turn them at regular intervals. If the heart and breathing stop, start CPR at once. A hospital health-education piece reposted by the Beijing Municipal Health Commission says: “Never let a drunk person sleep alone, or no one will be there to rescue them if they suffocate.” A pharmacist's article reposted by the Fujian Provincial Medical Products Administration says that a drunk person “must lie on their side”, and that a body temperature that is too low can cause the heart to stop. The US CDC counted an average of 2221 deaths a year from alcohol poisoning among people aged 15 and over in the United States in 2010 to 2012, about 6 a day.

The MedlinePlus first aid page of the US National Library of Medicine says: press on the wound directly with a hand to stop the bleeding, and raise the injured part. Life-threatening bleeding can be treated with a tourniquet. Keep the severed part and send it along with the person. If the cut end is dirty, rinse it gently first. Wrap it in a clean damp cloth, put it in a sealed plastic bag, and put the bag in ice water. If it is not in a bag, do not put it into water or ice, and do not put it directly on ice. Do not use dry ice, which will freeze the finger. If there is no cold water, try not to let it get warm. Cold lets the severed finger wait longer; without cold it can be reattached for “only about 4 to 6 hours”. Do not decide the severed part is too small to be worth keeping. Do not push the severed part or bone back in. The fingertip amputation page of the American Academy of Orthopaedic Surgeons agrees, and adds that it is best to go to a hospital where a hand surgeon is always on duty. Pooling 31 studies, 86.8% of reattached fingers survived (1976 fingers succeeded, 300 failed). Of 1087 people who had a replantation, 82.9% went back to work. A pooled analysis of another 12 studies found a replanted finger survival rate of 85.3%. Another pooled analysis of 12 studies and 3645 people found that fingers with 8 hours or more of ischemia before surgery were more likely to die after reattachment. The odds were about 2.25 times those of fingers under 8 hours: OR 2.25, 95% CI 1.43 to 3.54 (confidence range).

The NHS dental trauma page says: hold the tooth by the crown, the white part that shows above the gum, and do not touch the root. If the tooth is dirty, rinse it gently with milk, saline or saliva. Try to put it back into its original socket in the gum. If it goes in, bite gently on a clean cloth to hold it, and see a dentist as soon as possible. If it will not go back, keep it in milk or saliva. Do not put a baby tooth back, because it can hurt the permanent tooth growing below. If a tooth was knocked out and cannot be found, still book an emergency dental appointment. The steps on the “Save Your Tooth” poster of the International Association of Dental Traumatology are the same: find the tooth, hold it by the crown, stop up the sink and rinse it briefly under cold tap water. Then choose one of three: put it back in place, or put it in a cup of milk or saline, or hold it in the mouth between the cheek and the gum. Last, go to a dentist at once. The dental trauma database of the University Hospital in Copenhagen, Denmark, selected 145 permanent teeth in 116 people that had been knocked out and then put back, and followed them for 7 months to 23 years. It looked at the risk of the root fusing with the alveolar bone (ankylosis), after which the root is slowly resorbed. The rate was 17.2% for teeth put back on the spot, 55.3% for teeth soaked in saliva or saline and then put back, and 85.7% for teeth left dry for 1 hour or more. The same hospital had earlier followed a group of 400 teeth, which was re-analyzed in 2020. For teeth in children whose roots were not yet fully formed, the risk of ankylosis was 33.9% if left dry for less than 20 minutes and 60.0% if left for more than 60 minutes. For teeth with fully formed roots, it rose from 59.4% to 86.4%. Both groups are estimates at 900 days after replantation. The 1995 study of these 400 teeth also found that after soaking in tap water for more than 20 minutes, root resorption mostly appeared. During follow-up, 30% of these 400 teeth were eventually extracted.