TOPIC 6: ASSESS CASUALTY
1. Introduction
In community health practice, accidents and emergencies occur every day — from road traffic
accidents, domestic injuries, burns, animal bites, to sudden illnesses such as fainting or stroke.
Community health workers, first aiders, and public health officers are often the first people to
arrive at the scene before ambulances or doctors.
Therefore, it is very important to know how to assess a casualty correctly and quickly.
Definition:
Assessing a casualty means the systematic process of examining and evaluating an injured or ill
person to:
Identify any life-threatening conditions,
Provide immediate first aid,
Protect the casualty from further harm, and
Arrange for proper referral or evacuation.
Objectives of Casualty Assessment
1. To ensure safety of both rescuer and casualty.
2. To find out what happened and what type of injuries are present.
3. To identify urgent problems such as bleeding, breathing difficulties, or unconsciousness.
4. To provide appropriate emergency care and report findings to health facilities or
emergency services.
5. To record information for follow-up, legal, or reporting purposes.
2. Conducting Scene Size-Up
Scene size-up is the first step when you arrive at an emergency or accident scene. It means
looking around carefully to understand what has happened and what dangers may still exist.
Steps in Scene Size-Up
1. Stop and observe the environment before rushing in.
2. Identify potential dangers such as:
Fire, smoke, or leaking fuel.
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Live electric wires.
Sharp objects or broken glass.
Crowds or angry people.
3. Count the casualties: How many people are injured? Are they adults, children, or both?
4. Assess available resources: Do you have gloves, a first aid kit, or others to help you?
5. Decide whether it is safe to proceed or if you need to wait for additional help (e.g.,
police, fire brigade).
Example:
A matatu accident occurs along Kisumu–Busia road. Before touching anyone:
You check for leaking petrol (danger of explosion).
You observe that some victims are trapped.
You call for backup from police and ambulance.
This is scene size-up in action.
Importance:
Prevents rescuer injury.
Helps plan what to do first.
Saves time and organizes the response effectively.
3. Scene Safety
After observing the scene, you must ensure it is safe for you, the casualty, and bystanders.
Key Actions:
Wear protective gear such as gloves or a mask to avoid infection.
Move hazards if possible (e.g., switch off a car engine, remove sharp objects).
Prevent crowd interference by politely asking people to stay away.
Avoid moving casualties unnecessarily unless they are in danger (for example, near fire
or in the middle of the road).
In the Kenyan Context:
Community health volunteers (CHVs) and health officers often work with local chiefs, boda-
boda riders, or police to control crowds and keep scenes safe during emergencies.
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Why Safety Comes First:
If the rescuer becomes injured, there will be two casualties instead of one.
4. Determining the Nature of Injury or Illness
Once the scene is safe, the next step is to find out what is wrong with the casualty.
You must use your eyes, ears, and hands carefully.
How to Assess:
Look: Observe for bleeding, burns, swelling, deformities, or abnormal body positions.
Listen: For breathing sounds, cries of pain, or silence (a silent casualty may be
unconscious).
Feel: Check the skin’s temperature, pulse, and areas of tenderness or fractures.
Ask: If the person is conscious, ask what happened and where they feel pain.
Examples of Common Injuries:
Cause Possible Injury
Road traffic accident Fractures, bleeding, head injury
Burns (fire, hot water) Skin burns, shock
Fall from a tree Fractures, back injuries
Poisoning Nausea, vomiting, loss of consciousness
Animal bites Wounds, risk of rabies
Domestic accidents Cuts, falls, choking
Remember:
Always treat the most serious problem first — such as breathing problems or severe bleeding —
before attending to minor wounds.
5. Cordon the Scene and Secure the Casualty
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After identifying injuries, control the scene to make sure that only authorized people are allowed
near the casualty.
Actions:
Use ropes, sticks, tape, or even bystanders to form a boundary around the area.
Keep onlookers and vehicles away to give space for rescue work.
If possible, protect the casualty from rain, sun, or cold.
Do not allow people to lift or move the injured person carelessly.
Preserve any evidence if it is a criminal or road traffic case.
Why This Is Important:
Prevents more accidents.
Protects the casualty’s privacy and safety.
Helps emergency responders reach the scene quickly and work without interference.
6. Determining the Nature of the Incident
Understanding what caused the incident helps decide the kind of help or equipment needed.
Common Types of Incidents in Kenya:
1. Traumatic incidents: e.g., road accidents, falls, cuts, assaults.
2. Medical emergencies: e.g., heart attack, asthma attack, diabetic shock.
3. Environmental emergencies: e.g., snake bites, floods, landslides, drought-related
illnesses.
4. Disasters: e.g., building collapse, terrorist attacks, fires.
Actions:
Record what happened (time, location, number of casualties).
Inform emergency services and health facilities about the situation.
Report to relevant authorities such as the County Health Department or Kenya Red Cross.
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7. Managing Casualty Condition
After assessment, provide first aid or basic life support while waiting for further help.
The ABC Approach:
Step Action Purpose
Ensure the airway is open and clear. Tilt head back,
A - Airway To allow air into the lungs.
lift chin. Remove foreign objects like vomit.
Check if the person is breathing. If not, give rescue To provide oxygen and
B - Breathing
breaths (if trained). prevent brain damage.
C- Check pulse and bleeding. Control severe bleeding To maintain blood flow and
Circulation using pressure or bandages. prevent death.
Other Important Care:
Disability: Check consciousness using AVPU (Alert, Verbal, Pain, Unresponsive).
Exposure: Check for hidden injuries but maintain privacy.
Treat for shock: Lay casualty down, raise legs slightly, keep them warm.
Reassure the casualty — talk to them calmly.
Monitor vital signs (breathing, pulse, responsiveness) until help arrives.
8. Conducting Emergency Services
After providing first aid, ensure the casualty receives further medical attention.
Emergency Response in Kenya Includes:
Calling emergency numbers (999, 911, or 112).
Contacting local ambulance services such as:
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St. John Ambulance,
Kenya Red Cross,
County hospitals,
Faith-based hospitals.
Transporting casualties safely using available means — stretchers, wheelbarrows, or
vehicles — ensuring minimal movement of injuries.
Providing a report to the receiving medical team about what happened and what first aid
was given.
Coordination:
In Kenya, emergency response is often a multi-agency effort involving:
Police,
Fire brigade,
Health workers,
Local community leaders,
NGOs.
9. Identifying and Gathering Tools, Equipment, and Supplies
Effective casualty assessment and management require appropriate tools.
Basic Tools and Supplies:
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Category Examples
Protective equipment Gloves, mask, apron
First aid materials Bandages, gauze, antiseptic, scissors, tape
Transport equipment Stretcher, blanket, wheelbarrow, vehicle
Communication tools Phone, whistle, radio
Improvised materials Clean cloth (for bleeding), sticks (for splints)
Tip:
If you don’t have formal tools, improvise using available materials, provided they are clean and
safe.
10. Methods of Assessing Competence in “Assess Casualty”
During training or evaluation, several methods are used to assess whether a student or health
officer can correctly assess a casualty.
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Assessment Method Description
Trainer watches how you perform during a simulation or
Observation
real emergency.
Tests your understanding of steps, principles, and
Written Assessment
procedures.
You verbally explain what actions you would take and
Oral Assessment
why.
Feedback from supervisors or community leaders who
Third Party Reports
observed you in practice.
Collection of photos, reports, or checklists of your
Portfolio of Evidence
fieldwork.
Creating emergency plans or public health education
Projects
projects on first aid.
Performing a full casualty assessment in front of an
Practical Demonstration
examiner.
11. Learning Resources
Resource Type Examples / Description
Class materials provided by tutors covering steps and
Lecture Notes
scenarios.
- Community Health Practice in Kenya – Ministry of Health.
- First Aid Manual – St. John Ambulance.
Textbooks
- Emergency Care and Transportation of the Sick and Injured
– AAOS.
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Resource Type Examples / Description
Training Manuals Kenya Red Cross Society First Aid Training Guide.
Demonstration Videos Used in class to show real-life scenarios.
Community Drills Mock accident responses organized by health departments.
12. Summary
Assessing a casualty is one of the most critical life-saving skills in community health.
It involves:
Checking for safety,
Observing and identifying injuries,
Managing the casualty using the ABC approach,
Coordinating emergency services,
Keeping accurate records.
A well-trained community health worker or public health officer can save lives, reduce
disability, and promote safety awareness in their communities.
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