Victim Assessment
Victim Assessment is a step, that if overlooked can prove deadly for the victim. As important as having a working knowledge of wilderness emergecy medical skills is, that knowledge becomes hindered when you have no clue about the victims condition! So conducting an effective and accurate Victim Assessment if a critical step.
You can find many different methods of Victim Assessment. But they are all designed to provide you with the same knowledge. "What is wrong?" and "What should I do?".
Your approach will depend whether or not the patient is responsive or not. If responsive, the victim will hopefully be able to provide you with some vital clues. Even if they aren't fully responsive. If unresponsive, you will have to do your best to determine why.
Below I will provide you with a outline of the Initial Victim Assessment (IVA) and the Focused (Secondary) Victim Assessment (FVA). Note: The IVA/FVA should only be conducted (after) you after you have conducted your Scene Survey. This is clearly not an exhaustive explanation of Victim Assessment. These are just general guidelines. It is assumed that the reader has primary WFA training. If not, give me a call!
Questions to ask while checking the scene for safety:
-Am I OK, and am I going to stay OK? -Are the others OK, and are they going to stay OK? -Is the victim of this crisis OK, and are they going to stay OK? -What happened? What was the mechanism of injury (MOI)? -How do I safely approach the victim? -What is my general impression of how serious this is?
-Move on to your Victim Assessment.
Sequence of Patient Assessment:
Initial Assessment: (Unresponsive)
Use ABCDE method:
(A) Airway—Check the patient’s airway. (Assessing the Airway and Breathing can be done at the same time.)
(B) Breathing—Assess breathing.
(C) Circulation—Check for pulse, bleeding.
(D) Disability—Are spinal injuries suspected? (If unresponsive and no spinal injury is suspected, place in recovery position.)
(E) Environment—Assess the environmental threat. Exposure?
Focused Victim Assessment:
Head-to-Toe Exam
Check the patient from head to toe systematically to find any damage. Look for wounds, swelling, or other deformities. Ask where it hurts and if it hurts when touched. Feel gently but firmly. Be aware of unusual smells, such as breath odor, or sounds, such as coughing. If you suspect an injury may be hidden beneath clothing, you must take a look at skin level.
Check:
Head. Feel for depressions in the skull, open injuries, swelling, damage to the eyes, and fluid in the ears, nose, or mouth.
Neck. Feel both sides for pain or deformity.
Shoulders. Feel for pain, and look for symmetry between the shoulders. Include the collar bone as well.
Chest. Press both sides simultaneously and check for the ability to take a deep breath, as well as uneven breathing movements of the chest wall and abnormal breathing sounds. Press the sternum.
Abdomen. Gently press on all four quadrants (with the belly button as the central point) for pain.
Pelvis. Push on the two pelvic crests.
Genitals. Check if and only if it seems relevant.
Legs. Check with both hands, looking for symmetry and the ability to move the feet.
Arms. Check for symmetry and the ability to move the hands.
Back. Roll the patient (if found flat on her or his back) to assess the back. If you suspect a spinal injury, perform the roll carefully. Press on every bone of the spine.
Vital Signs
Vital signs are measurements of the physiologic processes necessary for normal functioning. They do not often tell you what is wrong, but they do tell you how the patient is doing. Changes in vital signs over time are indicators of changes in the condition of your patient. Check early and keep checking, and record your findings on your report form. To better monitor a patient, record the time at which you take a set of vitals on your report form.
Level of Responsiveness
The level of responsiveness (LOR) is a check on how well the brain is communicating with the outside world. Use the AVPU scale for quick reference:
(A) Is the patient alert and able to answer questions?
A+O×4: Patient knows who, where, when, and what happened.
A+O×3: Patient knows who, where, and when.
A+O×2: Patient can only relate who and where.
A+O×1: Patient only remembers who she or he is.
(V) Does the patient respond only to verbal stimuli, by grimacing or rolling away, for instance, from your voice when you speak or shout? In what way does she or he respond?
(P) Does she or he respond only to painful stimuli, such as a pinch? In what way does the patient respond?
(U) Is she or he unresponsive to any stimuli?
Heart Rate
To determine the heart rate (HR), count the number of heartbeats per minute. For speed, count for 15 seconds and multiply by four. Note the rhythm and quality of the pulse. Is it regular or irregular, weak or strong? Normal heart rates are strong and regular and are typically between 60 and 100 beats per minute.
Respiratory Rate
To determine the respiratory rate (RR), count the number of breaths per minute without telling the patient what you are doing. A patient who knows you are checking often alters the breathing rate in an attempt to be accommodating. Note the rhythm and quality of respirations. Normal lungs work about 12 to 20 times per minute at a regular and unlabored pace. Record any unusual noises associated with breathing.
Skin Color, Temperature, and Moisture
When assessing skin color, temperature, and moisture (SCTM), normal skin is pink (in nonpigmented areas such as the inner surface of the lips and eyelids), warm, and dry to your touch.
SAMPLE History
Usually, more information is gathered by subjective questioning than by objective checking.
This information is known as a patient’s history. Hopefully, the patient will provide the answers.
Sometimes witnesses are sources of important information. Ask calmly, and do not use leading questions. (For example, say, “Describe your pain” instead of “Is it a sharp pain?”) Be aware of your tone of voice, body language, and eye contact. Patients usually feel better and respond better if they think you are nice—but do not make promises you cannot keep. If you gain trust, you must maintain trust.
The SAMPLE Questions
(S) Ask the patient about his or her symptoms. Is the patient experiencing any pain, nausea, lightheadedness, or other things you can’t see?
(A) Ask the patient about his or her allergies. Are there any known allergic reactions? What happens? Has there been any recent exposure?
(M) Ask the patient about any medications he or she might be taking. Are they over-the-counter? Prescription? Why? When was it last taken?
(P) Ask the patient for any pertinent medical history. Has anything like this happened before? Is the patient currently under a physician’s care for anything?
(L) Ask the patient about his or her last intake and output: When was food or drink last taken? How much? When were the most recent urination and defecation? Were they normal?
(E) Ask the patient about the events leading up to the accident or illness. What led up to the events? Why did it happen?
