Initial assessment

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Initial assessment is an organized way to recognize and respond to life-threatening emergencies in a crisis. It can take from a few seconds to a minute, after which you either stay with the sick or injured person until further care arrives, or stay with them until both they and you agree it is o.k. for you to leave.

Contents 1 Take a deep breath 2 Survey the scene 2.1 Introduce yourself 2.2 Determine if the person is alert 2.3 Get their consent 2.4 Based on the MOI, do you suspect a spinal injury? 3 Check the ABCs 3.1 A-- is the Airway open? 3.2 B-- is the person Breathing? 3.3 C-- is their Circulation compromised? 3.4 D-- have they been Disabled? 3.5 E-- have they suffered / will they suffer Exposure to a dangerous environment? 4 Document your care 5 Re-assess as needed 6 Notes

[edit] Take a deep breath

Imagine one of your friends is suddenly injured or sick. Or maybe you're the first one to find a person "down" at a protest. What do you do? Well, don't panic! Take a deep breath and think.

[edit] Survey the scene

Before approaching, Survey the scene:

• Is it safe?
• How many people need help?
• What could be dangerous? Look for things like:
  • fire
  • falling debris
  • unstable structure
  • advancing police
  • an out-of-control crowd
  • traffic
• How will you get close to them and how can you get to safety?

Eliminate or prepare for potential hazards to the injured or ill person, to yourself, and to bystanders. Try to make sure that whatever happened to your friend or comrade doesn't happen to you too!

Universal precautions / BSI (Body substance isolation) While providing emergency care for others, it is important to also protect yourself from blood-borne diseases like HIV and hepatitis B or C. Wear latex or plastic gloves if you have to touch blood. It is best to wear them whenever providing medical care. No gloves? a plastic baggie will work in a pinch. Be aware that some people are allergic to latex; because of this more and more providers are switching to plastic (Nitrile) gloves. Remember, diseases can spread through rescue breathing (mouth-to-mouth resuscitation).

Use any crowd for moving obstacles, directing traffic, getting help, and keeping a safe space around injured people. Try to speak in a calm voice to help keep others calm. Remember, most people want to help.

[edit] Introduce yourself

• "Hi, I'm so-and-so. I know some first aid.

[edit] Determine if the person is alert

• "Are you OK?"
• "What's your name?"
• "Do you know where you are? /what day it is? /what happened?"

If the person does not respond to normal conversation, shout and tap-- but do not shake them, since this could make a neck or spine injury worse.

If the person does not respond to conversation, shouting, or tapping: Call 911. If other people are present, try to find a cell phone or send someone else to call 911 or look for help. Tell them to come back to let you know they called. If they don't come back in 10 minutes, send more people. Ask people nearby if they know what happened. Look for medical alert bracelets or necklaces that tell of a health condition. Emergency services personnel will not respond to what they consider an unsafe scene. If a person needs more help and emergency services are not available, call someone with more medical training, or try to find a car to transport the person to the hospital.

[edit] Get their consent

Find out if they are willing to accept your care. If they don't want to talk to you or be touched by you, or whatever, do your best to find out why and get them help that they will accept.

Consent Always say what you are about to do before touching them-- if this is an emergency, it is probably scary and they are giving you trust by letting you share it with them. Just like in sex, it is their body, and they have a right to say no to anything. But if you think their life is in danger, you have a responsibility to explain potential consequences, and to help them get care even if not directly from you.

What you discover during the first part of initial assessment affects how you do the second part. When you surveyed the scene and determined if the person was alert, you probably got an idea of the mechanism of injury or illness (MOI), which is a fancy word for the cause of the problem. Do you think the person fell? Were they in a fight? Are they twacked out on some stuff? Pay attention.

The most important thing to ask before going on is:

[edit] Based on the MOI, do you suspect a spinal injury?

Suspecting spinal injury If any part of the spine was fractured the spinal cord is at risk of being pinched, crushed, or severed. The most critical part of the spinal column is located in the cervical (neck) vertebrae. Act as if the cervical spine is injured if the injury involves: Any injury that leaves the person unconscious Sudden forceful stops (like a car accident) Falls from a height Diving from a height injuries Blunt trauma to the neck If you suspect a spinal injury, call 911, cradle their head to keep it still, and follow the spinal precautions included in the rest of this handout while you complete initial assessment.

[edit] Check the ABCs

This is a way to review the potential life-threats to a person before moving on to focus on one particular problem. Always assess and treat systems in their order of priority. A comes before B....

• Airway
• Breathing
• Circulation
• Disability
• Environment

[edit] A-- is the Airway open?

If the person talked to you normally, the airway is open. If they didn't talk, put your face next to theirs and look, listen, and feel for breathing for 15 seconds:

• Look to see if their chest rises
• Listen for sounds of breathing
• Can you feel breath on your cheek?

Interventions to open the airway: Manually open it with the head tilt/ chin lift (or with the jaw thrust if you suspect spinal injury) Manually expel material with the Heimlich maneuver (if you know how) If they are having an asthma attack, help them use their own inhaler and press the ping ch'uan points on their back If they are having an allergic reaction, they may need an epinephrine (Adrenalin) injection immediately. A double dose of diphenhydramine (Benadryl)-- usually 4 capsules-- orally may buy time Call 911 Keep their airway open by rolling them into recovery position

[edit] B-- is the person Breathing?

If they can talk normally to you, they are breathing, right?If they didn't talk, and there seems to be no airway obstruction, but no breath is coming out or in, the problem might be with their breathing system.

Interventions to start breathing: If they are in respiratory arrest (like from an overdose), try to keep them awake and breathing on their own by pinching their shoulder or earlobe If you can't keep them breathing on their own, start rescue breathing if you know how. Remember BSI Call 911 Keep their airway open by rolling them into recovery position

[edit] C-- is their Circulation compromised?

The circulatory system is contained within the heart and blood vessels. If the person is breathing, their heart is beating. Don't waste time taking their pulse unless you know how.

• Look for bleeding. Remember that bulky clothing, sand, or rocks might disguise blood loss. Blood loss may also be internal. Even if you find one bleeding injury, keep looking-- there may be other hidden injuries that are more severe.
• If they are pale, cool, and clammy, and if they are becoming less alert, consider that they may be entering shock.

Interventions to help the heart and stop bleeding: If their heart is not beating, find someone who knows CPR and call 911 If the person says they are having a heart attack, help them take their own Nitro pills and call 911 To stop bleeding, Apply firm direct pressure to the injury. Use a sterile gauze pad, a clean cloth, clothing, or even your gloved hand if necessary. If the person is able, they can put pressure on their own injury. Elevate the injured area above the level of the heart Don't lift the gauze or cloth to check if bleeding has stopped. This can dislodge the blood clot and make bleeding start again Call 911 for a bleeding emergency if: Bleeding does not stop in about 15 minutes A wound is spurting blood (this usually means an artery has been cut) If they become light-headed, help them lie down and slightly elevate their feet. Keep them warm

[edit] D-- have they been Disabled?

Any person who cannot think, move, or take care of themselves as they normally do-- or any person with a potential spinal injury-- is disabled.

• Stay with them until they recover or help arrives.

Interventions to help: If you suspect spinal injury, they should be kept still with calm words and hands on the head until help arrives. Call 911 If you suspect diabetic emergency, get them sugar and keep an eye on them If they are scared or traumatized, sit with them, listen to them, and help them breathe; but be realistic about the limits of your care. Help them find further care if they want it If they are intoxicated, keep an eye on them Call 911 if: The person has MOI for spinal injury The person does is unresponsive Sugar does not help a diabetic to recover The person presents a danger to self or others Keep an unresponsive person's airway open by rolling them into recovery position

[edit] E-- have they suffered / will they suffer Exposure to a dangerous environment?

While the environment in which you provide first aid might feel fine to you, pay attention to its effect on the sick or injured person.

• Extremes of heat and cold can complicate any first aid, but cold exposure is more dangerous than heat. Any person with serious blood-loss, burns, or any injury that leaves them disabled needs to be kept warm and dry in all but the hottest of weather.

Think of other environments which can seriously hurt an injured or sick person. Remember that the purpose of initial assessment is to discover threats to a person's life, and protect against those first, before providing general first aid.

Interventions to protect a person from a dangerous environment: If you can safely help someone leave a dangerous environment, do it. Negotiate with police, help them walk away, perform clothes-drag if appropriate. Only perform carries or BEAM if you are trained and it is necessary. Don't injure yourself! Be careful not to move someone into another dangerous environment (like where help cannot find you, where you can get boxed in, in front of glass walls in a protest situation) If the person is cold or could get cold, protect them from getting soaked with water. Pad under them and cover over them. Warm their hands and feet with your armpits if they want. Don't let yourself get too cold Learn how to use any crowd or bystanders to provide privacy, safety, or other needed help

[edit] Document your care

It is a good idea to keep notes about any problems you encounter in your initial assessment. Some medics put strips of duct tape on their pants and keep basic notes on it with permanent marker. They number their patients to maintain patient confidentiality, and take notes like this:

#1

19yo F w/(L) leg wound

"shot w/tear gas cannister"

A-- ok

B-- ok

C-- ok (minor bleeding (L) lower leg)

HR elevated w/i normal range

D-- difficulty moving w/o assistance

Pain 4 (out of 5) with pressure

E-- cold

Plan-- call 911, help her move inside warm bar, elevate leg, first aid.

Many medics write their notes after they have completed initial assessment and basic first aid, so that they can give the person all their attention. Documentation is always important, and becomes more important the more assessment skills you know, and the longer the person will be in your care.

[edit] Re-assess as needed

Signs for some life-threats take a while to show up. Keep an eye on the person while they are in your care. If they can talk, have a conversation. Not only is it good for their morale, but you can quickly assess changes in their level of alertness.

If the person's condition appears to change, assess again. Also, if you are going to be with the person a long time, assess them every few minutes, 15 minutes, hour, or few hours, depending on how injured or ill they are. Write down any changes for the better or worse.

[edit] Notes

It can be hard to tell what's wrong. Breathing problems may be due to asthma or anaphylaxis. Confusion could be due to diabetes, dehydration, psychological stress, or a head injury. Start from a place of love and respect, and harm none.

This material is intended as a training supplement. Reading this material is no substitute for first aid / medical training with a qualified trainer. We encourage you to pursue ongoing education, reviewing and upgrading your skills-- for the safety of both yourself and anyone you treat.