Initial AssessmentDetermining extent of injury
Gathering important information
What do you do when you approach a scene of an emergency?
1. Survey Scene Safety in 10 Seconds
2. Check for Response: AVPU3. Check for Breathing4. Check for Injuries: DOTS5. Get a medical history:
SAMPLE and OPQRST* Steps 4 and 5 can be reversed depending on the nature of the injury. Severe cases, step 4 is first. In non-immediate cases, do step 5 first.
1. Survey Scene Safety in 10 Seconds
• What dangers exist? – To victims? To others?– To self? (can you safely enter area to help?) * withdraw/get help when hazards exist
• Look for help – Have someone phone or phone yourself
• How many victims?• Cause of Injury? – Take Universal Precautions/BSI– Attend to quiet ones first– If victim(s) are alert, attain consent!
2. Check for Response: AVPU• Tap the person and shout, “Are you OK?”• Determine AVPU– A = Alert and Aware• Eyes open• Knows name, date, time, place
– V = Responds to verbal stimulus• Not oriented to time, place • Responds in a meaningful way
– P = Responds to painful stimulus• Eyes do not open• Responds w/ sternal rub or when trapezius muscle is pinched
– U = Unresponsive activate ERS (Emergency Response System)• Eyes do not open• Does not respond to pain
AVPU
3. Check for Breathing (no look, listen and feel!)
• Person is crying, speaking, coughing breathing!
• Person uses universal sign for choking: – Adult and Child: Heimlich maneuver – Infants: 5 back blows and 5 chest compressions
3. Check for Breathing (no look, listen and feel!)
• Person is “U”, not breathing, not breathing normally, or is gasping– Activate ERS (Emergency Response System) - 911– Get AED (Automatic External Defibrillator)– Check pulse simultaneously (5 – 10 seconds) while
assessing breathing– No pulse or weak pulse, begin CPR and use AED
4. Check for Injuries: Use DOTS
• Use DOTS to ascertain extent of injury.– D = Deformity – when bones are broken they move
out of place.– O = Open wounds breaking skin– T = Tenderness – sensitive to touch– S = Swelling
• DOTS can be rapid and focused or head to toe.– Rapid and Focused (trauma cases)– Head to toe (medical or non life-threatening cases)
DOTS: Head
• Head – Stabilize and maintain cervical spine– DOTS over sides of head, then back of head
Skull depressionBleedingCheck for leakage of fluid from mouth, nose &
ears (cerebrospinal fluid)Eyes (PEARL: Pupils Equal And React To Light)
• Neck– DOTS over back of neck
Check for Jugular Vein Distention (JVD) Check tracheal deviation (TD)
– Medical Alert Tags
DOTS: Neck
• Shoulders, Chest, Back– DOTS
Check for symmetry of shouldersSymmetrical expansion of chest
– Compress sides of chest for rib pain
DOTS: Shoulders, Chest, Back
DOTS: Abdomen• Abdomen
– DOTS Check all quadrants for
tenderness with overlapping hands and pads of fingers
Note areas of sensitivity (visceral organ damage)
DOTS: Pelvis
• Pelvis– DOTS
Incontinence or priapismSqueeze hips downwards with
palms of hands and squeeze hips toward each other
DOTS: Extremities• Extremities (legs then arms)
– DOTSCheck both front and back Check Symmetry
– CSM (Circulation, Sensation, Movement)
CSM
• Circulation Pulse (ex. radial and pedal pulse) Temperature/color (blue = cyanosis) Capillary refill >2 seconds is normal
• SensationCan person feel your touch on fingers/toes?
• MovementAsk person to wiggle fingers/toes, to squeeze your fingers and push foot against your hand.
When an injury is found…
• Expose the injury– If you can’t see it, it won’t be treated.– Remove clothing but try to maintain privacy• Explain what you intend to do and why
5. Get a Medical History
• OPQRST – Questions about a current injury or complaint
• SAMPLE– Questions about past medical history
OPQRST History• O – Onset
– What were you doing when this pain started? – Was it gradual? Sudden?
• P – Provoking– Does anything make it feel better or worse?
• Q – Quality– Describe the pain. Sharp? Burning? Numb?
• R – Radiation– Where is the pain, exactly? Does the pain travel?
• S – Severity– Rate the pain on a scale of 1 – 10, 10 being the worst
• T – Time– How long ago did this pain start?
SAMPLE History• S - Symptoms
• What is wrong?”• A – Allergies
• Are you allergic to anything?• M – Medications
• Are you taking any medications? What are they for?• P - Past medical history
• Have you had this problem before? Do you have any other medical problems?
• L - Last oral intake• When did you last eat/drink something?
• E - Events leading up to injury• How did you get hurt?
Until EMS arrives…• Regularly recheck every 15 minutes: (REx3)– Responsiveness/Breathing, Circulation, Effectiveness of 1st
Aid• Manage secondary injuries• Treat for Shock • Provide EMS with– Chief complaint– AVPU scale– DOTS findings– SAMPLE/OPQRST history (*allergies!)– Any first aid given