Chapter 3
First Aid for Colleges
and Universities
10 Edition
Victim
Assessment
Slide Presentation prepared by
Randall Benner, [Link]., NREMT-P
© 2012 Pearson Education, Inc.
Introduction
• Victim assessment is one of the most critical
aspects of providing first aid.
• Assessment is conducted to identify and care for
immediate life threats to the airway, breathing,
and circulation.
• Some injuries are obvious; some are hidden.
• A conscious victim may be able to guide you to
the problem—but an unconscious victim will be
of no help at all.
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Introduction
• The main goals of victim assessment are to
– Protect yourself from injury.
– Identify and correct life-threatening problems.
– Provide proper first aid care.
– Prepare the victim for transport.
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The Victim Assessment Routine
In most cases, conduct victim assessment in this
order:
• Size-up the scene.
• Establish rapport and control.
• Conduct a primary survey.
• Conduct a brief neurologic (neuro) exam.
• Determine the chief complaint.
• Assess vital signs.
• Look for medical information devices.
• Take a SAMPLE history.
• Conduct a secondary survey.
*Note: You may need to adapt or change the sequence, depending on your
experience and the specific emergency situation.
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Scene Size-Up
• Definition: an assessment of the scene and
surroundings.
• to ensure your own personal safety and
then to ensure the safety of the victim and
any bystanders at the scene.
Scene Size-Up
• The scene can provide 3 important clues to:
1-. whether the victim is injured or ill
Scene Size-Up
• The scene can provide clues to:
2- the number of victims you may need to
provide care for
Scene Size-Up
• The scene can provide clues to:
3- information to the EMS and what resources
will be needed to effectively manage the
victims and the scene.
There are five components of the scene
size-up:
• Take body substance isolation precautions by
using personal protective equipment (PPE).
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• Assess the safety of the scene.
- Prior to approaching the victim, quickly
scan the scene for any hazards, such as
downed power lines, spilled fuel, weapons,
or an unstable vehicle.
• Determine whether the victim is injured or ill.
• Determine the number of victims.
• Determine the resources needed.
Establish Rapport and Control
• To establish critical rapport with a potentially
scared, anxious, angry or in-shock victim, use
the Three C’s
– Competence
– Confidence
– Compassion
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Advices to establish control, do the
following:
• Move smoothly and deliberately (Observe clues
at the scene.)
• Ask the victim’s name, and use it.
• Identify yourself.
• Provide your credentials.
• Tell the victim what you want to do.
• Obtain the victim’s consent, if possible.
• Position yourself at a comfortable level in
relation to the victim. Stay where the victim can
see you without twisting his or her neck.
• Keep your eye level above that of the victim.
And Maintain eye contact.
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• Emotions escalate quickly in tense situations, so
keep your voice calm and quiet and Give orders
quietly.
• Conduct your survey in an unhurried, systematic
way.
• If there is more than one victim, determine which
victim(s) needs the most immediate care.
(provide care to those most seriously injured
first)
Victim assessment sequence
Conducting the Primary Survey
• Major goal of the primary survey is to check for
life-threatening problems to the airway,
breathing, and circulation.
• You have to consider the following:
- Every second the body is without oxygen it’s
closer to death.
- Compression and defibrillation are the most
valuable tools to use when a victim appears
lifeless.
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Primary survey sequences
• There are two main types of patients you
will encounter–those who appear to have
a pulse and those who don’t.
• Your primary survey will vary based on
this important determination.
Conducting the Primary Survey
1- The CAB approach to resuscitation: Circulation,
Airway, Breathing
2- Alternative is ABC: Airway, Breathing,
Circulation
• Look for any signs of life/breathing; movement,
speech
• Scan the chest for any signs of breathing.
• Breathing should be purposeful and adequate
• Agonal respirations = dying breaths; occasional,
gasping, ineffective breaths
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Conducting the Primary Survey
• If victim is conscious, ask (what happened).
- airway status,
- adequacy of breathing,
- mental status,
- mechanism of illness.
• Ask the victim (where it hurts). This will reveal
likely points of injury.
• Visually scan the victim for general appearance,
pale skin, blueness (cyanosis), and sweating.
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Conducting the Primary Survey
• ABCDs =
– Airway
– Breathing
– Circulation
• Disability (nervous system disability, or altered
responsiveness).
• Always suspect a possible spinal injury in the
victim who is unresponsive or who has an
altered mental status.
• Do nothing that could aggravate possible spinal
injury.
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Airway and Spine Stabilization
• Determine whether the airway is open
- If the victim is conscious and talking without
difficulty, the airway is open.
- If the airway is not clear: (snoring, strider,
gurgling, audible wheezing).
• If the airway is not open, use either the head-
tilt/chin-lift maneuver or the modified jaw-thrust
maneuver to open it
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• If you suspect the victim has a
spinal injury establish manual in-
line spinal stabilization by bringing
the victim’s head and neck into a
neutral in-line position.
• the nose is in line with the navel
(belly button) and the neck is not
bent forward or backward.
Suspect spinal injury if the victim
• Has a head or neck injury
• Is involved in any type of crash
• Falls from a height greater than their own
height
• Complains of pain to the neck or back
• Complains of tingling, numbness, or
unusual sensation in the extremities
Take precautions for spine injury when there
is a mechanism of injury and the victim:
• Appears to be intoxicated
• Has an altered mental status
• Is older than sixty-five years of age
Breathing
• A victim who is responsive and talking with ease is
breathing adequately
• Two measures determine breathing adequacy
– Rate: must not be too slow or too fast (Rates below 8
to 10 and above 40 usually don’t bring enough air into
the lungs to support life.)
– Depth: Victim must breath deeply enough to move air
to all parts of the lungs. (Adequate breathing is that
which moves the chest cavity significantly when you
observe or feel for movement).
• If the victim is not breathing spontaneously or not
breathing adequately has a pulse, begin artificial
breathing immediately
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Assessing Respiration
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Circulation
• Circulation
– Conscious victims Check the radial pulse; pulses
that are weak, too fast, or too slow, are of concern.
– if the victim is unresponsive or you can’t find the
radial pulse Check the carotid pulse.
– The victims who are lifeless and without adequate
breathing should receive compressions immediately.
There is no need to check a pulse
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• Note the victim’s skin color, temperature, and
condition.
- Skin that is moist, cool, and pale may indicate
shock.
- Cyanosis (bluish color) is a sign of hypoxia.
• If the victim is breathing and has a pulse,
continue by checking for serious or profuse
bleeding.
• Spurting or steady flow bleeding is the only kind
of bleeding that should be treated during the
primary survey.
• If you find major bleeding control it via direct
pressure.
Disability
• Injuries to the brain generally result in an altered
mental status or unresponsiveness indicates
decreased oxygen to the brain or brain injury.
• There are four general levels of consciousness:
– Alertness (victim’s eyes are open)
– Responsiveness to verbal stimuli
– Responsiveness to pain (grimaces, or jerks away
when pinched).
– Unresponsiveness
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• If the victim has an altered mental status
and adequate breathing should be
placed in a lateral recumbent position to
protect the airway.
• If a spine injury is suspected, keep the
victim in a supine position, maintaining the
head and neck in a neutral in-line position.
Conducting the Neuro Exam
• A neuro (neurologic) exam checks
– Mental status
– Motor function (e.g., voluntary movement)
– Sensory function (what the victim can feel)
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Conducting the Neuro Exam
• Talk to the victim. “What time is it?” indicates
victim orientation.
• If the victim is a child, observe their voluntary
movements and interest in surroundings.
• Monitor the victim’s speech for vagueness,
slurring, or garbled words indicates a
decreasing mental status or possible brain
injury.
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Conducting the Neuro Exam
• If the victim can’t speak, determine whether
victim can understand simple commands
Squeeze my hand
• If the victim has an altered mental status
determine how easily the victim can be aroused
with a small pain stimulus (such as a pinch
on the wrist).
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Chief Complaint
• Chief complaint The answer to the question
“Tell me where you hurt”.
• Most chief complaints are characterized by pain
or abnormal structure or function and can be
pinpointed using observations made by the
victim.
• Even if injury is obvious, it’s important to ask.
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Vital signs
• pulse, respiration, and relative skin temperature
• should be taken repeatedly at five-minute
intervals.
• Changes in vital signs reflect:
- changes in the victim’s condition
- effectiveness of your first aid care.
• Use your senses–sight, hearing, and touch
Pulse
• The pulse is the pressure wave
generated when the heart beats.
• it reflects the rhythm, rate, and
relative strength of the heart.
• take the pulse at any point where
an artery crosses over a bone or
lies near the skin.
• the best place in a conscious victim is at
the wrist.
• For unconscious, take the pulse at the
carotid artery (in the groove of the neck).
When you take the pulse, note its:
• Rate: Normal heart rate range is 60 to 100
beats per minute for an adult, 80 to 150 for
a child, and 120 to 160 for a newborn.
• Strength: A normal pulse is full and strong.
• Rhythm: A normal pulse is regular.
Respiration (Breathing)
• One respiration consists of one inhalation
and one exhalation.
• Normal respirations are easy and
spontaneous, without pain or effort.
• The normal range is 12 to 20 breaths per
minute for an adult, 15 to 30 for a child,
and 30 to 50 for a newborn.
• Place your hand on the victim’s chest, and
feel for chest movement.
• Do not tell the victim you are assessing
the respirations because this may alter the
rate.
• The chest should move up with each
breath.
Cardinal signs of respiratory distress
include:
• flaring of the nostrils;
• use of accessory muscles in the neck
• fast breathing;
• increased heart rate;
• pale and cool skin;
• sweating;
• and decreasing mental status.
Temperature and Skin Color
• Assess relative skin temperature by
placing the back of your hand against the
skin of the victim’s forehead, neck, or
abdomen.
• Normal skin is dry, as well as normal in
temperature.
• Hot skin temperature can be caused by
fever, heat stroke, or a hot environment.
• Low skin temperature can be caused by
shock, spinal injury, heat exhaustion, or
exposure to cold.
Skin color can tell you a lot about a victim:
• Paleness (white tone) may be caused by
shock, poor circulation, or heart attack.
• Redness may be caused by high blood
pressure, spinal cord injury, alcohol abuse,
sunburn, heat stroke, fever, or infectious
disease.
• Blueness (cyanosis) may be caused by
suffocation, lack of oxygen, heart attack,
or poisoning. (fingertips and around the
mouth).
• Capillary refill is one method of checking
circulation.
• measuring the time it takes for color to
return under the nail after relieving the
pressure. (Two seconds or less)
• If refill time is delayed, suspect shock or
decreased blood flow to that extremity.
• Measure capillary refill time by counting
“One one thousand, two one thousand,”
and so on
Looking for Medical Information Devices
• While taking vital signs, inspect for
medical identification devices, such as a
Medic Alert tag, necklace, or bracelet.
• Medical identification tags are often worn
by people with hidden medical conditions
• the victim’s medical problem and/or
medications
Taking a History
• Assess the scene; note the placement of the
victim or objects for clues.
• Ask questions, preferably open-ended ones
unless the situation is urgent.
• If the victim is unresponsive, confused, or a
child, talk to family, friends, or others
accompanying the victim.
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Taking a SAMPLE History
• S = Signs and symptoms the victim complains of
• A = What is the victim allergic to?
• M = What medications does the victim take?
• P = What is the victim’s pertinent past
medical history?
• L = When was the last time the victim had
something to eat or drink?
• E = What were the events prior to the incident?
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Conducting the Secondary Survey
• The secondary survey is a closer look at the
victim
• Conduct a full-body, head-to-toe assessment.
• Use your senses to collect additional
information.
• Checking for swelling, depression, deformity,
bleeding, and other problems.
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Conducting the Secondary Survey
• Look for deformities, wounds, bleeding,
discoloration, penetrations, neck openings,
unusual chest movement.
• Listen for unusual breathings, sounds, or
sensations.
• Feel for unusual masses, swelling, hardness,
stiffness, muscle spasms, pulsations,
tenderness, temperature.
• Smell for unusual odors on the victim’s
breath, body, or clothes.
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Conducting the Secondary Survey
• Inspect the following
– Face • Use DOTS to assess
signs or symptoms of
– Mouth
injury:
– Ears
- D Deformity
– Nose
- O Open wounds
– Skull and neck
- T Tenderness
– Chest
- S Swelling
– Abdomen
– Pelvic region
– Back
– Lower and upper extremities
Primary and Secondary Surveys
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