1. Initial Assessment Determining extent of injury Gathering important information

2. What do you do when you approach a scene of an emergency? 1.Survey Scene Safety in 10 Seconds 2.Check for Response: AVPU 3.Check for Breathing 4.Check for Injuries: DOTS 5.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.

3. 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!

4. 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

5. 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

6. 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

7. 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)

8. DOTS: Head Head – Stabilize and maintain cervical spine – DOTS over sides of head, then back of head Skull depression Bleeding Check for leakage of fluid from mouth, nose & ears (cerebrospinal fluid) Eyes (PEARL: Pupils Equal And React To Light)

9. Neck – DOTS over back of neck Check for Jugular Vein Distention (JVD) Check tracheal deviation (TD) – Medical Alert Tags DOTS: Neck

10. Shoulders, Chest, Back – DOTS Check for symmetry of shoulders Symmetrical expansion of chest – Compress sides of chest for rib pain DOTS: Shoulders, Chest, Back

11. DOTS: Abdomen Abdomen – DOTS Check all quadrants for tenderness with overlapping hands and pads of fingers Note areas of sensitivity (visceral organ damage)

12. DOTS: Pelvis Pelvis – DOTS Incontinence or priapism Squeeze hips downwards with palms of hands and squeeze hips toward each other

13. DOTS: Extremities Extremities (legs then arms) – DOTS Check both front and back Check Symmetry – CSM (Circulation, Sensation, Movement)

14. CSM Circulation Pulse (ex. radial and pedal pulse) Temperature/color (blue = cyanosis) Capillary refill >2 seconds is normal Sensation Can person feel your touch on fingers/toes? Movement Ask person to wiggle fingers/toes, to squeeze your fingers and push foot against your hand.

15. 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

16. 5. Get a Medical History OPQRST – Questions about a current injury or complaint SAMPLE – Questions about past medical history

17. 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?

18. 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?

19. Until EMS arrives… Regularly recheck every 15 minutes: (REx3) – Responsiveness/Breathing, Circulation, Effectiveness of 1 st Aid Manage secondary injuries Treat for Shock Provide EMS with – Chief complaint – AVPU scale – DOTS findings – SAMPLE/OPQRST history (*allergies!) – Any first aid given