Information - Initial Assessment

Background information for Key Stage 3 and parents.

How to approach a casualty

It does not matter what the incident is that you are attending, what has happened to the casualty or how many casualties you have, we always approach the incident in the same way. We carry out a Primary Survey on each casualty to understand
what is wrong with each casualty and to collect information to call the emergency services if they are needed, as well as to decide in which order to treat the casualties.

We can remember the Primary Survey as DRABC and is key to how we approach every casualty.

D
Danger

We check the area is safe for us to approach and if there are any dangers we deal with this first. If we cannot make the area safe to help the casualty, we contact the relevant emergency services for them to deal with the situation.
We cannot help a casualty if we are hurt.

R
Response

We approach the casualty, checking to see if they respond to us. If they have not responded by the time we reach them, we kneel down next to them, talking to them and gently shaking an adults shoulders to see if we get a response.

A
Airway

We need the airway to be open in order to breath. We can open the airway with the chin tilt and lift method when the casualty is on their back. On an adult, you place the palm of one hand on the forehead and two fingers of the other
hand under the chin. Gently tip the head back and lift the chin up to open the airway.

BBreathing

We watch to see if the casualty is breathing normally for up to 10 seconds, by watching to see if the chest rises and falls.

CCirculation

If the casualty is not breathing, we begin compressing the chest and getting a bystander to get help.
If the casualty is breathing, we look to see how circulation is by looking at skin colour, do they look pale at all or have any
injuries which will affect circulation.

How unresponsive is our casualty?

When someone goes unconscious they do not go instantly to 'sleep', there are levels in between. We often hear stories of casualties saying they could hear everything that was happening. When we assess a casualties response level, we are checking how
unconscious they are and how much they can tell us about their injuries.

When we check for a response, we approach the casualty by talking to them, gently shaking an adults shoulders and asking them to clasp our finger. Each of these checks their level of response, which we can remember as AVPU.

A
Alert

When we approach the casualty, they may look at us and start talking to us. They are alert and can tell us what has happened.

V
Voice

As we approach we talk to them and they talk back or make some noise in return. We know they are responding to voice and may be able to tell us what is wrong.

P
Pain

We gently shake an adults shoulders and they react with words or groans. We know they are responding to pain and may react if we were to touch a part of the body that was injured.

UUnresponsive

The casualty is unresponsive and is not going to be able to tell us what is wrong or react to any injuries. If we want to know what injuries they have, we will have to find them by looking.

We can continually monitor AVPU as we treat the casualty and monitor if the AVPU scale is going up or down, which would indicate if they are improving or worsening.

What else can we consider as we approach the casualty?

As we approach the casualty we can see where they are, how they are positioned, what is around them and what they are holding. This can tell us a lot of things and make us consider how the injury may have been caused.

  • Where are they? - As we approach we will get an idea of what has caused the injury and what might be hurting. If they laying at the bottom of the stairs, they may have fallen down them and injured their back. If they are holding their head and
    a baseball at is on the ground near them, they may have been hit with it.
  • How are they positioned? - In general, people will try to position themselves to make themselves more comfortable. If they are sitting bolt upright with neck extended, they may be having breathing difficulties.
  • What is around them? - Things around people will be signs of what is wrong. Sick on the floor will indicate they have thrown up or blood will indicate they have somewhere cut themselves.
  • What are they holding? - We try to protect what is hurting and the position of our hands can indicate what is wrong. If they are holding their chest and left arm, they may be having a heart attack. If they holding their leg, they may have sprained
    or broken it.

What do I do with the information?

Once you have checked every patient to check if they have an airway and are breathing, you can contact the emergency services with the information. We will look at how to contact the emergency services in the next session.

Putting it into practice

What dangers are in this image and how would you deal with it?

Man laying on the ground electrocuted by a drill

Considerations

The man is holding a drill and appears to be still on the ground with his head tucked into his chest, which would affect breathing.

There is danger from the cables and the electric should be turned off before you approach. You should get an adult to deal with this.

In the position found, the casualty is probably unresponsive, so U on the AVPU scale.

Once the electric is turned off, the casualty needs to be turned onto their back and the airway opened. An ambulance needs to be called immediately for this casualty.