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Accurate casualty treatment, and later medical treatment, depends on accurate and detailed information from the incident scene.

At an incident it is important that you note as much information as you can. Details such as the estimated speed at which a car was moving, the way it hit an object, the size and shape of that object and whether the casualty was conscious or unconscious when you arrived.

Note all this and report it to the ambulance personnel or doctor. These are important details for emergency personnel trying to evaluate the casualty’s injuries. You must approach the incident in a confident and methodical way. This not only allows you to gain information, but also presents you as someone who knows what they are doing. This attitude imparts confidence to the casualty and bystanders.

The approach Take the time to look at the scene for anything that may threaten your safety or the safety of those on or around the scene.

Look for the number of casualties involved. Look for bystanders who may be able to supply information on what happened and the number of casualties.


What are your impressions as you approach the incident?

• Is it a road traffic accident?
• Has a person fallen from a ladder?

Quickly confirm in your mind just what is present; bystanders, other vehicles, power lines, power cables, or collapsed structures.


Primary examination Check to see if the casualty is conscious. If unconscious treat as per the Emergency Action Plan.
Check to see if there is severe life threatening bleeding and control immediately.

Try to obtain a history from:

• The casualty
• Bystanders

At this point you are able to decide what approach and treatment is appropriate.
If the casualty is conscious ask three important questions:

1. What happened?
2. Where does it hurt the most?
3. Can you take a deep breath?

These three questions will give you information from the casualty, including whether the casualty remembers the incident (were they unconscious), what injury hurts the most, and if any chest injuries may be affecting breathing.

Pay attention to:
History – the incident (SAMPLE)

• Signs And Symptoms
• Allergies
• Medication
• Past illnesses
• Last time the casualty ate or drank
• Event – history of injury/illness (what happened, where and when)

Signs – what you can see or feel for yourself

• Bleeding, swelling, bruising

Symptoms – what the casualty tells you

• Pain, blurred vision, nausea

Observations One of the most important things a first aider can do is to take and record accurate observations. There are four vital observations that should be, if at all possible, written down against the time and the name of the casualty. These observations are:

• Skin appearance
• Conscious state
• Pulse
• Respiration

The first set of these observations, once taken and recorded, becomes the ‘baseline observations’. All changes in the casualty’s observations are measured against this baseline for improvement or worsening of their condition.

Skin Appearance The appearance of the skin can be a good indicator of the casualty’s condition. Check colour, condition and temperature of the skin.

Colourcheck the colour of skin in the mouth and lips. Red, pink, pale or blue. (Checking the lining of the mouth and lips allows a quick assessment of casualties from all ethnic backgrounds). TemperatureIs the skin warm or cool to touch? ConditionIs the skin dry or wet?

Conscious StateCheck the casualty for a response by touching the casualty on the shoulders and asking loudly ‘are you all right’?

Note the following:

• Is the casualty alert and aware of time and place?
• Is the casualty confused, violent or agitated?
• Is the casualty roused by touch or pain?

There are 4 levels of consciousness (AVPU).

• 1) Alert – the casualty is responsive and alert and aware of time and place.
• 2) Responsive to Verbal stimulus – the casualty is not aware of time and place.
• 3) The casualty responds only to Painful stimuli.
• 4) Unresponsive – the casualty does not respond to stimuli.

Pulse The pulse can be difficult to find and should only be used when time permits and when assessing a casualty that is breathing. DO NOT use a pulse to determine if resuscitation is required.

The neck is the best location to check for a pulse, which is called the carotid. The carotid is the strongest and most easily accessible of all the pulse points. The radial pulse (wrist) is often the easiest to find. When taking a pulse, note how fast the pulse rate is over one minute. A normal adult will have a pulse rate of 60 to 100 beats per minute. Children and babies have a faster heart rate than adults. Note the rate, rhythm and strength of the pulse.

• Rate – How many beats per minute? Count for 15 seconds and multiply by 4
  • Adults – 60 to 100 beats per minute
  • Children – 90 to 130 beats per minute
  • Infants – 120 to 160 beats per minute
• Rhythm – Is the pulse regular or irregular?
• Strength – Is the pulse strong or weak?

Respiration

• Rate – How many breaths per minute? Count for 15 seconds and multiply by 4
• Rhythm – Is the breathing regular or irregular?
• Sounds – Is there gasping, gurgling, wheezing or snoring?

Pain Pain can be one of the most difficult observations to make as every person has a different ‘pain threshold’. Ask open questions such as “can you describe your pain to me”, not “does your pain feel sharp”.

As pain is subjective the first aider needs to use a tool such as the PQRST of pain.

• Provocation - What brought the pain on? Did the pain start when the casualty was at rest or did it start with activity or injury?
• Quality - How is the pain described? Is it intermittent, sharp, dull, heavy, burning or an ache?
  
• Region/Radiation - Where is the pain situated, and does it travel to other areas of the body?
  
• Severity - Measure the pain on a scale of 1 to 10. A rating of 10 on this scale would be severe pain.
  
• Time - How long ago did the pain start?

Secondary examination Now that you know the casualty’s basic observations and condition you have more time to thoroughly examine a conscious casualty by systematically Looking and Feeling (LAF).

• Look for deformity, wounds and swelling
• And
• Feel for deformity, tenderness and swelling

A good tool to remember the signs of injury is DOTS.

• Deformity
• Open wounds
• Tenderness
• Swelling

Conduct a head-to-toes secondary examination. Remember to be sensitive to the age, sex and culture of the casualty.

Start the secondary examination by informing the casualty of what you are going to do and the reason for doing the examination. Listen carefully to what the casualty tells you while doing your examination.

Head: Bleeding Fractures Bruising Swelling Tenderness or pain Cerebral spinal fluid (CSF) from ears. CSF is a clear colourless fluid that may also have blood present Ask casualty to bite to check for fractured jaw Neck: Bleeding Fractures Bruising Swelling Deformity Tenderness or pain Numbness or tingling Check for Medical Alert necklace Ask casualty to wiggle fingers and toes Ask casualty to squeeze your hands to check for strength Shoulders and chest: Bruising Swelling Gently ‘spring’ the ribs to check for tenderness or pain Look for unequal rise of the chest with each breath abdomen and pelvis: Rigidity Tenderness or pain Swelling ‘Guarding’ and incontinence Gently ‘spring’ the pelvis to check for tenderness or pain Arms and legs: Bleeding Fractures Soft tissue injuries Tenderness or pain Loss of strength Check for medical alert bracelet Check circulation in extremities Ask casualty to move each limb in turn Back and Spine: Bleeding Deformity Tenderness or pain ‘Log roll’ and look at all areas of the back of the casualty for signs of injury