❤️‍🩹First Aid Unit 2 – Assessing the Scene and Primary Survey

Key Concepts and Terminology

• First aid involves providing immediate care to an injured or ill person until professional medical help arrives
• The primary survey (ABCDE) is a systematic approach to quickly assess and treat life-threatening conditions
  • Airway: Ensure the airway is open and clear
  • Breathing: Check for normal breathing and provide rescue breaths if needed
  • Circulation: Assess pulse and control any severe bleeding
  • Disability: Evaluate the person's level of consciousness (AVPU scale)
  • Exposure: Remove clothing as needed to examine for further injuries
• Scene safety is the first priority when approaching an emergency situation
• Triage is the process of prioritizing care based on the severity of injuries in a multi-casualty incident
• Personal protective equipment (PPE) includes gloves, masks, and eye protection to prevent exposure to bodily fluids
• The Good Samaritan law provides legal protection for those who offer reasonable assistance to someone in need

Scene Safety and Approach

• Ensure personal safety by assessing potential hazards (traffic, fire, gas leaks, unstable structures) before approaching
• Call for help and request additional resources (ambulance, fire department) as needed
• Use appropriate PPE to protect against blood-borne pathogens and other infectious materials
• Introduce yourself as a first aider and obtain consent before providing care, if possible
• If the scene becomes unsafe, retreat to a safe distance and wait for help to arrive
• Be aware of potential crime scenes and avoid disturbing evidence
• Consider the mechanism of injury (fall, car accident) to anticipate potential injuries

Initial Assessment Overview

• Perform a quick visual assessment of the scene and the injured person
• Check for responsiveness by gently tapping the person's shoulders and asking, "Are you okay?"
  • If unresponsive, shout for help and check for breathing
• If responsive, ask for permission to help and gather information about the incident and any medical conditions
• Assess the person's level of consciousness using the AVPU scale (Alert, Verbal, Pain, Unresponsive)
• Look for any life-threatening conditions (severe bleeding, lack of breathing) that require immediate intervention
• Continuously monitor the person's condition and provide reassurance throughout the assessment

Primary Survey Steps (ABCDE)

• Airway: Open the airway by tilting the head and lifting the chin (head-tilt/chin-lift maneuver)
  • If a neck injury is suspected, use the jaw-thrust maneuver instead
  • Remove any visible obstructions from the mouth (loose teeth, vomit)
• Breathing: Look, listen, and feel for normal breathing for 5-10 seconds
  • If not breathing normally, provide rescue breaths (2 breaths initially, then 1 breath every 5-6 seconds)
• Circulation: Check for a pulse at the carotid artery (neck) for 5-10 seconds
  • If no pulse, begin chest compressions (30 compressions to 2 breaths) and use an AED if available
  • Control any severe bleeding by applying direct pressure and elevating the limb if possible
• Disability: Assess the person's level of consciousness and pupil response
  • Use the AVPU scale and note any changes in mental status
• Exposure: Remove clothing as needed to examine for further injuries, but maintain the person's dignity and prevent hypothermia

Common Hazards and Precautions

• Traffic: Ensure the scene is safe from oncoming vehicles by placing warning triangles or flares
• Fire: Evacuate the area immediately and call the fire department
  • Do not attempt to fight the fire unless it is small and you have the proper training and equipment
• Electrical hazards: Do not approach or touch any downed power lines or electrical equipment
  • Wait for the utility company to shut off the power before providing care
• Hazardous materials (chemicals, gas leaks): Identify the substance if possible and relay the information to emergency services
  • Evacuate the area and avoid contact with the substance
• Unstable structures (collapsed buildings, landslides): Do not enter the area and wait for specialized rescue teams
• Violent or agitated individuals: Maintain a safe distance and wait for law enforcement to secure the scene

Triage in Multi-Casualty Situations

• Triage is the process of sorting and prioritizing casualties based on the severity of their injuries
• The goal is to provide the greatest good for the greatest number of people with the available resources
• The START (Simple Triage and Rapid Treatment) method is commonly used in mass casualty incidents
  • Walking wounded (minor injuries) are directed to a safe area
  • Remaining casualties are assessed for respirations, perfusion, and mental status
  • Casualties are tagged with color-coded labels (red, yellow, green, black) based on the severity of their injuries
• Provide care to the most critically injured first, while also directing others to assist with less severe cases
• Continuously reassess casualties and adjust priorities as needed

Documentation and Handover

• Record pertinent information about the incident, the casualties, and the care provided
  • Include the time, location, mechanism of injury, and any changes in the person's condition
• Use a standardized format (SAMPLE history) to gather information from the casualty or bystanders
  • Signs/Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading up to the incident
• Provide a clear and concise handover to emergency medical services when they arrive
  • Summarize the incident, the casualty's condition, and any care provided
• Ensure the continuity of care by sharing relevant information and assisting with the transfer of the casualty

Practical Tips and Common Mistakes

• Always prioritize personal safety and avoid becoming another casualty
• Use gloves and other PPE consistently to prevent exposure to bodily fluids
• Be aware of the limitations of your skills and equipment, and do not attempt procedures beyond your training
• Regularly reassess the casualty's condition and adjust your care plan as needed
• Keep the casualty warm and comfortable, but avoid moving them unnecessarily
• Do not give the casualty anything to eat or drink, as this may interfere with medical treatment
• Avoid using tourniquets unless you have been properly trained, as they can cause tissue damage if applied incorrectly
• Do not remove any impaled objects, as this may worsen bleeding