In any given first aid event, our first challenge will always be a successful patient assessment. For First Aid Responders this has been broken down into:
The Primary Survey
The objective of the primary survey is to ensure your own safety and to determine any immediate life-threatening impairments. The process is best described using the helpful acronym DRABC.
Before making any attempt to assist your own safety must come first. You cannot help if you become ill or injured yourself. At work this could mean cutting the power supply to machinery or stopping vehicles such as lorries, forklifts, tractors etc. In the community and at home it may translate into stopping a football match or turning off cookers. Often there are no hazards present, the most common precaution is to simply put on a pair of latex gloves to protect from body fluids. Nevertheless it will always remain a case of ‘Safety First’.
Check the patients response. Tell them your name and ask if you can help? They may or may not respond. We could tap them on the shoulders and ask if they can hear you or open their eyes? A patients level of responsiveness can be gauged using the AVPU scale which we will describe in more detail later on. At this point it is helpful to note that if the patient responds in an alert fashion, able to speak, this means that their airway is open and they are breathing – a good sign!
If the patient is unresponsive you can ensure their airway is open by lifting their chin and tilting their head back. You can also look into their mouth to see if there is anything obviously blocking their airway. However do not perform a blind finger sweep. Only take something out of the patients mouth if you can see it and it is easy to do so. Choking is a scenario in which a person may be responsive but their airway is blocked. For guidelines on how to respond check out our section on choking.
Watch the patients chest to see if they are breathing. Take a minimum of 5 but no longer than 10 seconds to check for chest rise. If the patient is not responding and they are not breathing, call 999/112 & start CPR beginning with chest compressions.
Is the patient bleeding heavily? If so we need to treat immediately by calling 999/112 & applying direct pressure to the wound.
The Secondary Survey
The objective of a secondary survey is to identify any further illness or injury that may require treatment. There are several components to help first aiders conduct a successful secondary survey as part of their patient assessment:
Although not intended as a sequential set of checks in practice, SAMPLE provides a useful way of learning the key components of a secondary survey. It stands for:
Signs relate to what can you see, hear, feel or smell to indicate the persons condition? For example you may see blood on clothing or hear wheezing in the patients breathing. Symptoms refer to what the patient can tell you about how they feel i.e. dizzy, cold, nauseous.
Ask the patient if they have any allergies. This could explain difficulty breathing in relation to a bee sting or after eating a food they have an allergy to. It may also reveal a contraindication to medication, for example aspirin.
Ask the patient if they are taking any medications that they need you to help with. This could be an inhaler to relieve an asthmatic episode or tablets to relieve angina. We can help by getting them for the patient.
Does the patient suffer from any known medical condition e.g. epilepsy or has the patient experienced the same symptoms before e.g. chest pain.
What did they last eat or drink & when?
Can the patient tell you what led to their condition or was anyone else around that can tell you?
CPGs Patient Assessment – Secondary Survey Medical:
The title ‘head to toe’ survey can feel quite daunting for the First Aid Responder. Contrary to assessing the patient fully from head to toe, a better description is to assess visually and physically as the event history dictates. Depending on the events leading to the injury or illness as well as the signs and symptoms, you may feel it helpful to examine a particular area of the patients body to determine if there are any further signs indicating the need for treatment. These can include:
Deformities, blood, cuts or any sign of trauma. Fluid oozing from ear or mouth. Pupil size and reaction.
Again checking visually for deformities, blood or any sign of trauma. A physical check may include very gently checking tenderness appropriately or asking the patient to clench fingers and toes in order to check sensation or motor control.