C ASUALTY A SSESSMENT (P RIMARY AND S ECONDARY S URVEY ) N OTE : NOTES BASED ON NON MASS - CAT SITUATIONS Prepared By: Corps SO(5) Wilson Cheng Wei Sheng Clementi Town Corps Corps Liason Officer Last Updated: 12 August 2010

B Y THE END OF TODAY …… Perform Casualty Assessment Primary Survey Secondary Survey Perform Handover to Paramedics

W HAT SHOULD I DO ?

G ENERAL S ITUATION 5 Simple Steps: Step 1: Assess The Environment Step 2: Assess Casualty’s Condition Step 3: Determine and Perform Necessary Treatment Step 4: Maintain and Monitor Casualty’s Condition Step 5: Hand-over to Paramedic

G ENERAL S ITUATION 5 Simple Steps: Step 1: Assess The Environment Step 2: Assess Casualty’s Condition Step 3: Determine and Perform Necessary Treatment Step 4: Maintain and Monitor Casualty’s Condition Step 5: Hand-over to Paramedic

S TEP 1: A SSESS T HE E NVIRONMENT DANGER Is it safe for you to approach? No Is hazard removable/ Avoidable? Yes Proceed to Step 2. No Can Casualty be moved to safety? Yes Remove/Avoid hazard and proceed to Step 2. No Call for Ambulance and wait for Paramedics Yes Move Casualty and proceed to Step 2 Yes Move Casualty and proceed to Step 2 Safety is important: The Worst kind of First Aider is a dead one.

W ARNING : W HEN N OT TO MOVE CASUALTY Complains of pain to the neck or spine Has gone through a very high impact trauma or accident Has been flung or thrown off a distance Has a serious head injury Has been pinned under a heavy object for over an hour

BUT…… If there is immediate danger to the casualty or first aider’s life, where the situation cannot be eliminated or controlled: MOVE THE CASUALTY!!! Even if casualty suffers from the above mentioned situation.

C ASE S TUDY 1

C ASE STUDY 2

C ASE STUDY 3

G ENERAL S ITUATION 5 Simple Steps: Step 1: Assess The Environment Step 2: Assess Casualty’s Condition Step 3: Determine and Perform Necessary Treatment Step 4: Maintain and Monitor Casualty’s Condition Step 5: Hand-over to Paramedic

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION Assess Steps: Check Level of Conscious Check Upper Spine Check ABC Head to Toe Body Survey Skin If possible, put casualty to recovery / sitting position

S TEP 2: A CCESS C ASUALTY ’ S C ONDITION Approach Casualty carefully and approach him/her from his/her feet direction first Determine Casualty’s level of conscious (AVPU) Gently tap the shoulders of the casualty and ask “Hello Hello, Are you ok?” Casualty Response No Response Proceed to check neck, ABC and perform CPR if necessary. If there is two first aiders is present, the other FA is to perform primary survey co-currently (Bottom-up approach). Ask Casualty where he/she feels pain/discomfort Comfort the Casualty Inform Casualty that you will check for injuries and perform primary survey If there is two first aiders is present, the other FA is to treat any visible injuries first.

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION P RIMARY S URVEY Head to Toe assessment to locate any injuries (especially non-visible injuries) and allow necessary treatment to be performed early. Assessment should be quick ( between 30 seconds to 2 minutes) Assessment uses your senses ( Touch, Sight, hearing and smell) If casualty is conscious, casualty is able to assist you by responding to you if he/she feels any sensations.

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION P RIMARY S URVEY Upper Spine survey Run your fingers gently along the spine from the base of the skull and move downwards as far as possible without disturbing the casualty’s position Check for: Irregularity Swelling Tenderness Loosen Clothing around neck, belt, take off shoe and socks, remove all hard objects in pockets and look for medical warning bracelets or stoma in the windpipe

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION P RIMARY S URVEY Check ABC Airway Any obstructions? Any dentures? Any burn marks/wounds on lips or in mouth? Breath Rate, depth and nature (easy or difficult, noisy or quiet) Does chest expands evenly, easily and equally on both sides? Circulation Pulse per minute, nature (quick or slow, deep or shallow) Note: Proceed with CPR if ABC not present

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION P RIMARY S URVEY Head Run hand carefully over scalp. Look for – Bleeding, Swelling or Depressions If casualty is conscious, speak to each side of the ear to determine if casualty can respond. Look for blood or clear fluid oozing out for either ear Check if eyes are open: Check size of pupils Any foreign objects, bloody or bruising in the white of the eyes. Check nose: Any discharge

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION P RIMARY S URVEY Body Feel along both collar bones and shoulders : Deformity, Irregularity or Tenderness Feel along ribcage: Deformity, Irregularity or Tenderness Grating sound/unusual when breathing Any bleeding Check Movement for arms, elbows, wrists and fingers : Run your hand downs each arm (using one arm as reference to the other) Deformity, Irregularity or Tenderness Any Bleeding Bend and straighten arm and hands Check Circulation on each fingers

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION P RIMARY S URVEY Body Lower Spine If there is any impairment in movement or loss of sensation in limbs, do not move casualty to examine the spine. If not, gently pass your hand under the hollow of the back and feel along the spine Check for swelling or tenderness Abdomen Gently feel for any bleeding, rigidity or tenderness of the abdomen muscular wall.

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION P RIMARY S URVEY Lower body Feel both sides of the hips. Gently try rocking the pelvis to feel for signs of fracture. check if any bleeding or incontinence Use both hands and feel the entire length of leg. If casualty is conscious and alert, ask casualty to assist you by moving ankles and knees Look and feel for any bleeding, swelling, deformity or tenderness Check circulation for each toes

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION P RIMARY S URVEY Skin Color, temperature and state of skin Is it pale, flushed or grey-blue? Is it hot or cold, dry or damp? Is it blue? Is there bruising at the area?

Q UICK T EST Name the steps for primary survey What should we look out for when we are surveying casualty’s Breath? What should we look out for when we look at skin?

S TEP 2: A SSESS C ASUALTY ’ S C ONDITION S ECONDARY S URVEY Carry out secondary survey (If treatment is non- critical or if there is a second first aider present) External clues Medication Warming bracelets Auto injector Inhalers Getting a full picture of the accident/incident from by-standers/witnesses How incident happen? Any injuries sustained? Medical History? Environment? Time of injuries?

G ENERAL S ITUATION 5 Simple Steps: Step 1: Assess The Environment Step 2: Assess Casualty’s Condition Step 3: Determine and Perform Necessary Treatment Step 4: Maintain and Monitor Casualty’s Condition Step 5: Hand-over to Paramedic

S TEP 3: DETERMINE AND PERFORM NECESSARY TREATMENT This is where the other areas of First Aid comes in: CPR and AED Choking Transportation of Casualty Wound and Bleeding Bites and Stings Environmental Injuries Respiratory Problems Bones, Joints and Muscle Injuries Other Simple Medical Problems

G ENERAL S ITUATION 5 Simple Steps: Step 1: Assess The Environment Step 2: Assess Casualty’s Condition Step 3: Determine and Perform Necessary Treatment Step 4: Maintain and Monitor Casualty’s Condition Step 5: Hand-over to Paramedic

S TEP 4: M AINTAIN AND M ONITOR C ASUALTY ’ S C ONDITION Regularly Monitor and record vital signs Level of response Pulse Breathing Any deterioration of condition Arrange for After care Ambulance Family member Allow casualty to go home and advise casualty to see a doctor

S TEP 4: M AINTAIN AND M ONITOR C ASUALTY ’ S C ONDITION

G ENERAL S ITUATION 5 Simple Steps: Step 1: Assess The Environment Step 2: Assess Casualty’s Condition Step 3: Determine and Perform Necessary Treatment Step 4: Maintain and Monitor Casualty’s Condition Step 5: Hand-over to Paramedic

S TEP 5: H ANDOVER TO P ARAMEDICS Reporting to Paramedics Advice is to write down the required information( Get passer by to write) Information valuable to Paramedics: Casualty’s Name and address History of incident or illness Brief description of any injuries Any unusual behavior Any treatment given, and when Level of response, pulse and breathing.