1. Finding Out What’s Wrong: Victim Assessment
Chapter 4

2. You have just arrived at the site of an emergency
You have just arrived at the site of an emergency. What should you do first?

3. Step 1: Survey The Scene Piece together the puzzle
Look for dangerous hazards
Quickly determine:
The number of victims
The cause of injury
Are there witnesses?

4. Survey The Scene #2
Do not approach the victim if threat exists

5. Survey The Scene #3 Attain consent Gain victim’s confidence
Identify problems
Don’t assume that the injury you see is the only one
Gather info that will be helpful to EMS

6. Survey The Scene #4
Remain calm
Call EMS if needed
Do not move the victim unless it is necessary to support life or life threat exists

7. Step 2: The Initial Victim Assessment
Identify and correct life threatening conditions related to
Airway
Breathing
Circulation
Disablity

8. Goal of the Initial Assessment
To assess heart, lung, brain and spinal cord functioning (address life support – does the victim need CPR?)
Cardio Pulmonary Resuscitation
Cardio refers to heart
Pulmonary refers to lungs
Resuscitate refers to revival

9. How To Proceed Through The Initial Assessment: RAPABCD
R - check for responsiveness
A – alert
V – responds to voice
P – responds to pain
U – unconscious, no responses
A - activate EMS (911)
P - position victim on the back

10. How To Proceed #2: RAP ABCD (checking for vital signs - pulse and respiration)
A - Airway
B - Breathing
C - Circulation
D – disability

11. Airway Open the airway by “head tilt, chin lift”
If spinal cord injury is suspected, be more cautious
Jaw thrust

12. Breathing
Look, listen, and feel for breathing (no more than 10 seconds)
Normal respiration rates (per minute)
for adults: 12-20
, < 8 or > 24 need care
children 30
baby 40

13. Circulation Check for signs of circulation: 10 seconds Breathing
Coughing
Movement
Skin color (pale or blue) and temperature (hot, cold, cool or moist)
Feel forehead with back of hand
Search for severe bleeding
** pulse at the carotid artery nearest you

14. Normal pulse rates: Adults: 60 - 100 Children: 80 - 100
Lower for fit and hypothermic
Children:
Babies:

15. Initial Victim Assessment: Physical Exam
Head to toe for major injury or unresponsive
Minor injury, examine complaint only
More regarding head to toe exam will follow

16. The Physical Exam Identify yourself Obtain consent
Ask and use the victim’s name
Ask about chief complaint
Use SAMPLE to help you remember questions to ask the victim

17. Questions To Ask: SAMPLE
S - symptoms
symptom: something the victim tells the first aider
sign: something the first aider sees, hears, or feels
A - Allergies

18. Sample #2 M - Medication P - Pre-existing illnesses
L - Last food (food poisoning? hypoglycemia?)
E - Events prior to the injury

19. Steps of The Secondary Survey or Physical Exam
Systematically look and feel (LAF)
Look for: DOTS
D - deformity
O - open wounds
T - tenderness
S - swelling
Start with the head for adults, feet for children

20. Check The Head DOTS Feel both sides of the head
CSF fluid (clear fluid from ear or nose / halo effect)

21. Check Eyes: PEARL Are pupils equal and react to light?
Use flashlight or cover one eye with a hand
Pupils normally contract in one second
No pupil reaction could mean death, coma, cataracts, artificial eye

22. Check Eyes #2
Pupil dilation occurs within seconds of a cardiac arrest
Look for unequal pupils (stroke, head or brain injury)
Check inner eye lid: it should be pink

23. Check Neck and Chest Check for cuts, bruises, compare sides
Apply slight pressure to sides of chest (checking for broken ribs)

24. Abdomen Ask if pain is present
If pain is present, gently press on opposite side of pain site to help determine area affected
Feel for lumps
Feel the 4 abdominal quadrants

25. Pelvis
Gently press downward and squeeze inward

26. Extremity Assessment Check arms and legs deformity tenderness
Check for :
C - Circulation (pulse sites)
S - Sensation
M - Movement

27. Extremity Assessment #2
Compare extremities
Check temperature of the extremity
Check nail bed
instant refilling means good circulation
normal refill time is < 2 seconds

28. Spine and Back Ask victim about movement in extremities
Wiggle fingers, toes
Have victim press foot against your hand
Have victim squeeze your hand
Babinski reflex test
Injured? Big toe flexes upward

29. Check for a Medical Alert Tag
24 hour emergency phone number
Do not remove tag unless absolutely necessary

30. Reassess ABC’s: Every 5 minutes if unconscious
Every 15 minutes if conscious

31. Role Play Secondary Survey
Lab Activity

32. Is There a Head or Spinal Injury?
Always stabilize the head immediately
P 192, 193 – 195
Details on subsequent slide

33. Signs of Spinal Cord Injuries
Painful movement of arms and legs
Numbness, tingling, weakness, burning, lessened sensation in arms or legs
Loss of bowel or bladder control
Paralysis of arms or legs
Deformity

34. Always Remember! RAPABCD

35. Post Emergency Numbers Near The Telephone
Fire department
Police
Ambulance or EMS (paramedics)
Physician
Poison Control Center

36. Have You Ever Called 911?

37. Calling Emergency Medical Services (EMS - 911)
A two minute delay in calling EMS can be deadly
If in doubt, call EMS
Questions by dispatchers are not to question the need of the call but to determine the level of need

38. What To Tell 911 Dispatcher
First, speak slowly and clearly
When calling from a cell phone, give the address immediately
Listen carefully to the dispatcher

39. Tell The Dispatcher : Location Telephone number What has happened
Number of persons needing help
Special conditions
Your assessment of the victim
Do not hang up unless the dispatcher instructs you to