How to do a Patient Assessement
The management of someone injured is probably the most important topic in all injuries, sports, and outdoor medicine. There are four effective survey techniques that are used in your initial assessment of a sick or injured person. These four survey techniques are:
scene survey
primary survey
secondary survey
ongoing survey
1. Scene Survey
The first survey technique is the scene survey. When you first approach a scene, the tendency is to approach the patient immediately and start rendering aid. Don’t. You must first make sure that the scene is safe before you enter to assess the victim. Potential hazards include bikers on single-track trails that could come around a corner and hit the rescuer(s) and injured bikers. This survey should take only a few moments. This can effectively be performed while discovering the mechanism of injury (MOI) and the nature of the illness (NOI).
2. Primary Survey
The second survey technique is the primary survey. The purpose of the primary survey is to keep the victim alive. To help prioritize the treatment of injuries during the primary survey, refer to the table below which uses the MARCH acronym. It’s important to note that preventing major haemorrhages is the top priority, even coming before Airway.
Primary Survey prioritization using MARCH
M Massive haemorrhage
A Airway (with C-spine precautions)
R Respiration
C Circulation
H Hypothermia/Hyperthermia
Anytime there is major bleeding you should always take steps to stop the bleeding first. Typically, direct pressure is done to stop heavy bleeding. Away from help, however, don’t hesitate to use a tourniquet. It is a fast and simple method to stop a major bleed.
If a victim is unresponsive, assume there is a C-spine injury even if there is no clear mechanism. Therefore, for Airway, you should hold the C-spine as a precaution during your primary assessment. If the patient becomes responsive later, you can re-evaluate the need to hold C-spine.
Next, you can quickly check for a victim’s Respiration before evaluating their pulse. Checking the pulse falls under Circulation when using MARCH. If they are not breathing, or if they do not have a pulse, you will need to initiate CPR at this time.
Hypothermia/Hyperthermia refers to making sure that the patient is warm and dry and whether the patient will need to be evacuated or not (thus the alternative of Hike vs. Helicopter). Using the MARCH prioritization as you quickly go through the primary survey ensures that your patient is alive and as stable as possible. Learn it well!
3. Secondary Survey
The third survey technique is the secondary survey. This survey is done after the primary survey and can be remembered using the SAMPLE acronym.
Secondary Survey using SAMPLE
S Symptoms/Subjective
A Allergies
M Medications
P Prior medical history
L Last oral intake (food and/or drink)
E Events leading up to illness/injury
Address these items to the victim as questions and pay close attention to what they say. It they cannot answer, ask if family, friends, or people at the scene might be able to help with some or all the questions. As well, you can look for medical alert tags and bracelets on the victim. Check backpacks, purses and wallets for medical information too.
4. Ongoing Survey
The fourth survey technique is the ongoing survey. You should repeat this survey as often as needed. If the patient is unstable, go through the survey more frequently. Until the patient is in the hands of medical help, you should continue assessing them with the Ongoing survey.
If at any time, there is a change in the patient’s status you should always go back and repeat the primary assessment. This is essential to determine what caused the change in the patient’s medical status.
Ongoing Survey using AVPU
A Alert
V Verbal
P Pain
U Unresponsive
Scene Safety
In a case where the scene is not safe for the victim, you may need to move them to a safe location. For example, consider a situation where a biker falls in a race and is right on the trail. This fallen person is now in danger of being hit. Should you move the patient to a safer location and risk causing a potential spinal injury? Clearly, the scene is not safe. You need to move the injured person away from the trail. If you started treating the victim here, you would be subjecting the victim, yourself, and other rescuers to additional injury.
When considering scene safety, it is important to keep in mind the risk-to-benefit ratio. Moving the victim(s) may result in spinal injury but keeping them at the base of the cliff could result in more injury or even death if there is a rockfall. In this case, the risk of rockfall outweighs the risk of spinal injury in moving the patient. Be careful of the spine!
Blood Sweep
A crashed biker could easily have cuts on their skin. A quick look will determine if they are bleeding. This is known as the blood sweep and allows you to identify any major bleeding. It’s important to look under layers of clothing when doing your sweep, as blood can collect between these layers. It’s recommended to perform the sweep in small segments to determine where the bleeding is coming from.
The blood sweep also allows you to find deformities in the musculoskeletal system. A crashed biker might have internal bleeding. There is little you can do if someone is bleeding to death inside their body, other than evacuate them as quickly as possible. At least you will know to do this. Remember also, that people will often bleed on the ‘street’ or they will bleed in one place and then stumble to another place. Be sure to look on the ground or the street for blood.
If you follow these steps and use the acronyms, the chances of you missing something is extremely small. Even if you do not have the knowledge or experience to treat the patient, you will have the information when you hand patient care over to a medical health and emergency care provider.
