When an injury happens in a remote area swift action is often needed. However, prior to any kind of treatment, a quick but thorough review of the victim should be conducted in order to determine which treatment is necessary.
Wilderness First Aid training teaches that the process of checking a patient is divided into two stages: the initial assessment, in which general information about the patient's condition is gathered, and a secondary stage in which targeted areas of the patient's body and state are tested in greater detail. These processes follow a series of small tests – often known by easy to remember initialisms or acronyms – which are covered in a generally in this overview.
Initial Assessment of the Injured
The purpose of an initial exam is to determine whether a victim's life is in any immediate danger. The process recommended by the American Red Cross in their course on Wilderness First Aid (which is based on the Boy Scouts of America's Wilderness First Aid Curriculum and Doctrine Guidelines) employs the well known maxim, "look, listen and feel" and can best be remembered by the initials ABCDE. The initials signify the steps of opening the Airway (A), checking for Breathing (B), feeling for a Circulation or a pulse (C), looking for spinal Damage or Disability (D) and checking for injuries relating to Exposure to the elements (E).
ABCDE is a quick way to reveal signs that the victim's life is in danger. If such signs are found, emergency life-sustaining treatment, such as CPR or use of an AED, should be carried out and trained medical help should be contacted immediately. It is also important to document the scene, information gleaned from the initial assessment and any pertinent information about the incident and those involved, all of which will be passed along to responders.
If the initial assessment suggests that the victim's condition is not life-threatening then a secondary assessment should be conducted to gain more insight into the victim's ailment(s).
Secondary Assessment of Injuries
The more focused secondary assessment of an injured person in the wilderness should employ several examinations to determine a patient's mental and physical state as well as how the injuries were sustained.
A good place to begin a secondary exam in the relatively hands-off AVPU test to determine the patient's Level of Responsiveness (LOR). If the patient's LOR is conducive to answering questions, it is important to then collect SAMPLE information.
SAMPLE stands for Signs, Allergies, Medications, Past (medical history), Last (food/stool) and Events. Collections of this information on incident report form could inform medical attention the patient receives upon returning from the wilderness.
Once the hands-off AVPU and SAMPLE tests are complete, a hands-on physical exam known as DOTS should be conducted to give a clearer picture of the patients physical state. DOTS stands for Deformity, Open injuries, Tenderness and Swelling, and a patient should be checked beginning at the head and proceeding down the body and out to the extremities for any signs of these conditions.
During the DOTS test, it's also a good idea to get a clearer picture of the patient's circulation, sensation and motion (or CSM) than was acquired during any of the initial exams. Noting the patient's CSM as well as any irregularities in pallor, or body temperature, on an injury report form could also be beneficial in informing later treatment.
Taking Action Following Injury Assessment
Conducting an initial assessment of an injured person's vital signs is the best first step in caring for the injured victim in the wilderness (remember the "Three Cs" of Wilderness First Aid). Following it up with secondary exams like AVPU, SAMPLE and DOTS will give a clearer picture of the exactly nature of the injuries and inform the care provided.
Disclaimer: The information contained in this article is the sole responsibility of the writer. It is provided for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a qualified health professional. Any reader who is concerned about his or her health, or the health of another person, should contact a doctor for advice.
Willis Eddington - Pugilist in the Mean City
