Everyone will treat someone else who has been injured! Experts estimate that everyone will witness one or two injuries that threaten life. During emergency situations when panic exists, knowing what to do and what not to do can be vital. It could mean the difference between life and death or temporary or permanent disability.
Assessment is the cornerstone of good injury care. The first goal is to find out the victim's injury and/or condition. Next, all life-threatening conditions must rapidly be found and, if needed, resuscitation must start. Thirdly, all conditions needing attention prior to moving the victim must be addressed. Some conditions require calling the emergency medical services (EMS) system or, if thought safe, transporting the injured person without the use of an ambulance.
An assessment is divided into two parts:
- Primary survey for life-threatening conditions.
- Secondary survey for non-emergency conditions.
Primary survey
The goal of the primary survey is to find and correct life-threatening conditions. Most primary surveys will be quickly completed since most injured victims you will see won't have life-threatening conditions.
If the primary survey uncovers any problems, such as an obstructed airway or massive bleeding, you must attend to them immediately before proceeding with the rest of the assessment.
The primary survey steps can be remembered by using the acronym ABC2D2E:
A - Airway open? If the victim is talking or is conscious, the airway is open. For an unconscious person, open the airway with the head tilt/chin lift method unless a neck injury is suspected in which case you use a modified jaw thrust.
B - Breathing? Conscious people are breathing. However, note any breathing difficulties or unusual breathing sounds. If the victim is unconscious, keep the airway open and look for the chest to rise and fall, listen for breathing, and feel for air coming out of the victim's nose and mouth.
C2 - Circulation?
1. Check circulation by feeling for a pulse at the side of the neck (carotid artery). If a pulse is absent, cardiopulmonary resuscitation (CPR) is required.
2. Check for severe bleeding by looking over the entire body for blood (blood-soaked clothing and/
or blood pooling on the floor or the ground). Bleeding requires the application of direct pressure (could use a pressure dressing and bandage).
D2 - Disability
1. Spine. Suspect a spine injury when any event (such as a fall or automobile crash) occurs that could produce spine injury. If a spine injury is suspected, do not move the victim's head or neck.
2. Consciousness level. In order to avoid confusing terms such as "semi-conscious" and "in and out," relate the victim's consciousness to one of four levels on the "AVPU" scale. The V, P and U levels can help determine damage from a decrease of oxygen to the brain, drug or alcohol overdose, central nervous system injury or metabolic derangement from diabetes, seizure or heart.
AVPU scale:
A - Alert. Eyes open and the person can answer questions in a clear manner. He or she knows the date (time?), where they are (place?), and their own name (person?).
V - Response to Verbal stimulus. Eyes do not open and the person may not be oriented to time, place and person but does respond in some meaningful way when spoken to.
P - Responsive only to Painful stimulus. Eyes do not open and does not respond to verbal questions. Person responds to pinching of the skin.
U - Unresponsive to any stimulus. The person does not respond to pinching of the skin.
E - Expose and examine. Clothing may be hiding an injury or a severe bleeding site. How much clothing should be removed varies, depending on what conditions or injuries are found. The general rule is to remove as much clothing as necessary to determine the presence or absence of a condition or injury. Avoid hypothermia since most injured victims will be susceptible.
The secondary survey will identify injuries and/or conditions that do not pose an immediate threat to life but may do so if they remain undetected and uncorrected. Even minor injuries need treatment. This "looking and feeling" survey systematically starts at the head and proceeds down the body to the feet.
Medical personnel at all levels are taught a systematic method of assessing an injured person. These assessment methods vary, but all follow a similar format. Presented here is a method that can be recalled during those hectic, panicky, emergency situations when you may be wondering what to do first.
- Alton Thygerson is a professor of health sciences at Brigham Young University.