Initial AssessmentDetermining extent of injury

Gathering important information

What do you do when you approach a scene of an emergency?

1. Survey Scene Safety in 10 Seconds

2. Check for Response: AVPU3. Check for Breathing4. Check for Injuries: DOTS5. 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.

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!

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

AVPU

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

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

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)

DOTS: Head

• Head – Stabilize and maintain cervical spine– DOTS over sides of head, then back of head

Skull depressionBleedingCheck for leakage of fluid from mouth, nose &

ears (cerebrospinal fluid)Eyes (PEARL: Pupils Equal And React To Light)

• Neck– DOTS over back of neck

Check for Jugular Vein Distention (JVD) Check tracheal deviation (TD)

– Medical Alert Tags

DOTS: Neck

• Shoulders, Chest, Back– DOTS

Check for symmetry of shouldersSymmetrical expansion of chest

– Compress sides of chest for rib pain

DOTS: Shoulders, Chest, Back

DOTS: Abdomen• Abdomen

– DOTS Check all quadrants for

tenderness with overlapping hands and pads of fingers

Note areas of sensitivity (visceral organ damage)

DOTS: Pelvis

• Pelvis– DOTS

Incontinence or priapismSqueeze hips downwards with

palms of hands and squeeze hips toward each other

DOTS: Extremities• Extremities (legs then arms)

– DOTSCheck both front and back Check Symmetry

– CSM (Circulation, Sensation, Movement)

CSM

• Circulation Pulse (ex. radial and pedal pulse) Temperature/color (blue = cyanosis) Capillary refill >2 seconds is normal

• SensationCan person feel your touch on fingers/toes?

• MovementAsk person to wiggle fingers/toes, to squeeze your fingers and push foot against your hand.

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

5. Get a Medical History

• OPQRST – Questions about a current injury or complaint

• SAMPLE– Questions about past medical history

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?

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?

Until EMS arrives…• Regularly recheck every 15 minutes: (REx3)– Responsiveness/Breathing, Circulation, Effectiveness of 1st

Aid• Manage secondary injuries• Treat for Shock • Provide EMS with– Chief complaint– AVPU scale– DOTS findings– SAMPLE/OPQRST history (*allergies!)– Any first aid given