Assessment of the Scene and Patient
Assessment for CPR/first aid has 4 basic components:
- Scene size-up
- Primary (or initial) assessment
- Secondary assessment
- Ongoing assessment (if advanced medical care is delayed)
In addition, the call for advanced medical care should be made at the appropriate point during assessment. This could be at any time a serious or life-threatening condition is recognized. To see the entire assessment procedure in a wilderness setting, go to either Wilderness Assessment or NOLS TV assessment.
Even though assessment is often described as a linear procedure, you must be flexible and responsive to the circumstances of the emergency. To read an article about performing assessment in a nonlinear manner, go to Patient Assessment, a Nonlinear Approach.
When sizing up the scene, you must answer the following 4 questions:
- Is the scene safe or can it be made safe (i.e., by rescue or other action)?
- What happened?
- How many victims?
- What resources are needed?
The answers to these questions will help you determine whether you can safely approach the victim, how to continue the assessment, and, ultimately, what care to provide. In the case of multiple victims, it also helps you determine which victim to care for first and what must be done to coordinate a multiple-victim response.
- Overview of scene size-up
- Rescuing/moving the victim
- Scene safety
- Police officer rushes in, succumbs to gas poisoning (the YNC.com) – Warning! This video shows the death of a police officer.
- Another police officer get caught in an ammonia gas leak (WALA) – This officer was hospitalized and did recovered.
- Good samaritans electrocuted trying to help car crash victim (MSNBC)
- Rescue 911: Episode 522 “Brothers Pool Shock” (Rescue 911) – Father makes a unique rescue after 2 brothers are electrocuted, one after another.
- Resources for first aid
- Automated external defibrillator (AED)
- Emergency oxygen
- First aid kit
The primary (or initial) assessment consists of the following:
- Forming a general impression of the patient
- Checking responsiveness
- Opening the airway and checking for breathing and a pulse
- Checking for severe bleeding
All patients, whether responsive or unresponsive, should be checked using the primary assessment. For unresponsive patients, the primary assessment will indicate the basic life support care that must be provided. For responsive patients, the general impression and severe bleeding checks are still required, and taking a few seconds to monitor breathing and pulse will help determine if the patient is in distress.
- Primary assessment of athletic injuries (Human Kinetics)
- Primary assessment using DRSABCD (Xpress First Aid)
Forming a general impression of the patient will help you determine your immediate course of action. Questions to ask yourself when forming the general impression include:
- Does the patient look sick or injured?
- Is there an obvious mechanism of injury (MOI)?
- Are spinal stabilization precautions necessary?
- Is the patient conscious and alert?
- Is the patient breathing?
- Is the patient bleeding?
- What is the patient’s approximate age? – For CPR/first aid, a child is 1 to 12 years of age, an infant is less than 1 year old, and an adult is over 12. For AED use, a child is 1 to 8 years of age or someone weighing less than 55 pounds.
Answering these questions may alert you to a serious problem that requires basic life-support measures and additional resources, or it may identify a minor problem that you can take care of easily.
You can assess the patient’s level of consciousness using the AVPU scale. AVPU stands for Alert, Verbal responsive, Pain responsive, and Unresponsive.
- If the patient appears alert, asking orientation questions (see the AVPU scale) will enable you to rate his or her orientation on a scale of 1 to 4.
- If the patient appears unconscious, lightly tapping or shaking the patient while shouting “are you OK?” can confirm unresponsiveness. A patient who is semiconscious will react to your touch or your voice.
Another scale to rate responsiveness, especially after a head injury, is called the Glasgow Coma Scale (GCS). A GCS score is based on 3 parameters: eye opening (E), verbal response (V), and motor response (M). For more information, go to Glasgow Coma Scale.
Airway, breathing, and circulation (pulse)
Next, you need to check the airway, breathing, and circulation status of the patient (the ABCs).
- With a conscious or semiconscious patient, verify that the airway is clear and breathing is normal. A patient with normal breathing has a pulse.
- With an unresponsive patient, open the airway and check breathing for no more than 10 seconds. (Professional rescuers should check breathing and a pulse for no more 10 seconds.)
To check for severe bleeding, look up and down the patient’s body for blood spurting or flowing rapidly from a wound. Severe bleeding must be taken care of right away; minor bleeding can be cared for after the patient has been stabilized. To learn how to care for severe bleeding, go to the Trauma page.
The secondary assessment is a check for nonlife-threatening conditions. If you are the only rescuer and the patient is unconscious, you need to care for any life-threatening conditions first before performing this assessment. If the patient is conscious with no life-threatening conditions (i.e., not choking, severely bleeding, etc.), perform this assessment to determine the patient’s chief complaint and to find any signs of illness or injury to care for.
The secondary assessment consists of:
- Obtaining a patient history
- Chief complaint
- Mechanism of injury or nature of illness
- SAMPLE history
- Performing a physical exam (focused, rapid, or detailed as appropriate)
- Obtaining baseline vital signs
- Respiratory rate
- Pulse rate
- Skin temperature and characteristics
- Pupil appearance
The following links provide additional information:
- Full secondary assessment
- Physical exam
- Vital signs
If advanced medical personnel are delayed, you should perform an ongoing assessment to identify and care for any changes to the patient’s c0nditions in a timely manner and to monitor the effectiveness of interventions and care already provided. To perform the ongoing assessment, you should reassess the following:
- Chief complaint
- Primary assessment
- Vital signs
- Interventions and care already provided
Patients who are unstable should be reassessed every 5 minutes or more often if indicated by the patient’s condition. Stable patients should be reassessed every 15 minutes. The physical exam and patient history do not have to be repeated unless there is a specific reason to do so. If a life-threatening condition occurs at any time, stop secondary or ongoing assessment activities and provide appropriate care immediately.
Record the results of each ongoing assessment with the findings obtained during the primary and secondary assessments. Turn this information over to advanced medical personnel.
The call to 9-1-1 (United States and Canada) or the local emergency number should be made as soon as you identify a life-threatening or serious illness or injury. This can happen at any point in the assessment procedure.