Practicing a full patient check on the flanks of Mt. Shasta

A hiker falls down in the woods…

Pre-Assessment

“Is the scene safe?”

That’s the mantra repeated many dozens of times in any Red Cross course and Wilderness and Remote First Aid is no different.  The subsequent steps include checking the patient, calling for help (if available), and providing care—thus forming the Red Cross emergency action steps: CHECK—CALL—CARE.

The Wilderness Medicine Institute recommends a slightly different, yet valuable a five step process, recently documented in Backpacker Magazine.  The best part is it rhymes!  To remember the steps, you need to put your hand up to your forehead as if viewing something from a distance. This signifies keeping a safe space between you and the potentially dangerous situation, and it also reminds you of the five steps (one for each finger on your forehead.)

Here are the steps to run through mentally—or out loud if you’re so inclined:

#1: I’m Number 1!  (Protect yourself first)

#2: What happened to you? (look for the mechanism of injury)

#3: No germs on me! (Put your gloves on!)

#4: Are there any more? (Patients, that is)

#5: Are you dead or alive?(Get a general impression of the patient.  E.g. are you about to perform CPR or put a band-aid on them?)

Paul Peltzoldt, founder of the National Outdoor Leadership School has some additional advice: “sit down and smoke a cigarette if you get in a tough situation, and that’s pretty darn good counsel for any situation where things come flying at you quickly.”  (Tom Reed, NOLS)  Bear in mind that he said this in the sixties and neither I nor NOLS are encouraging smoking—but you get the concept: calm down, slow down, and think.

Primary Assessment
This should be similar to what you have learned in CPR

Greet the patient, identify yourself and your level of training, and gain consent to help them.  Have another responder stabilize the patient’s head/spine while you continue.  If the patient can speak, find out their chief complaint.  The ABCDE steps in the Primary Assessment are designed to check for life-threatening conditions.  If at any time you find one of such conditions, stop and treat it.  Here are the Red Cross steps:

  • A–Check airway.  A patient who can speak has an open airway, is breathing and has a pulse
  • B–Assess breathing.  If the patient is not breathing, immediately begin rescue breathing or CPR
  • C–Assess circulation.  Check for a pulse in a child.  Then, for an adult  and child, perform a quick scan for severe bleeding.  If you find severe bleeding, immediately expose the wound and use direct pressure to control the bleeding.
  • D–Look for disability as a result of damage to the spinal cord.  If you suspect a spinal injury, keep a hand on the patient’s head or ask someone else to take control of the patient’s head and tell the patient to remain still.
  • E–Assess the threat of the environment and expose any injuries.  Look for exposure to extreme environmental conditions but, if necessary, you may expose part of the patient’s skin to assess the damage and to give care.
  • If there are no life-threats, continue with the secondary assessment and SAMPLE history.

Stay tuned for secondary assessment…

southbaytrek

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