OSH 1252

FIRST AID AND EMERGENCY PLANNING

CHAPTER 2:
CASUALTY’S ASSESSMENT
 LEARNING OUTCOMES
At the end of the topic, students should be able
to:

• Describe mass casualty incidents - triage

• Describe a primary and secondary survey
 INTRODUCTION
• Casualty’s assessment is one of the most critical aspects of
providing first aid.

• Assessment is conducted to identify and care for immediate

life threats to the airway, breathing, and circulation.

• Some injuries are obvious; some are hidden.

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• The main goals of casualty assessment are to:

 Protect yourself from injury.

 Identify and correct life-threatening problems.
 Render proper first aid care.
 Prepare the casualty for transport.

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 MASS CASUALTY
INCIDENTS – TRIAGE
The processing of incidents involving more than
one casualty entails sorting the casualties
according to what treatments will be applied. This
sorting process is called ‘triage’.

Triage: Sorting casualties according to severities of

injuries
• sort patients into those who need critical
attention and immediate transport to the
hospital and those with less serious injuries
Treatment should be given in priority order:

HIGHEST PRIORITY
• those that must be moved to prevent further
injury;
• life-threatening injuries that can be helped; e.g.
airway or breathing problems,
• circulation problems, or severe bleeding.
 TRIAGE – Colour Tagging
System
• Priority 1 (RED) - life threatening; may survive if
given immediate life saving measures
• Priority 2 (YELLOW)- potentially serious but not
immediately life-threatening; may survive if given
care within a few hours
• Priority 3 (GREEN) - "Walking-wounded“ victims
who are not seriously injured; do not require
rapid care
• Priority 4 (BLACK) – deceased or severely injured
patients unlikely to survive
LOWEST PRIORITY

• non-life-threatening injuries; e.g. fractures, pain.

• minor injuries that are definitely not life
threatening;
• life-threatening injuries that can NOT be
helped;
• people that are obviously dead as a result of
their injuries.
For casualty assessment there are to 2 stages:

• Primary survey (DRSABCD) - try to get a

response from the casualty

• Verbal secondary survey - the second stage is

carried out using the ‘no touch technique’ and
involves a visual and verbal examination of
his/her injuries without touching them.
 PRIMARY SURVEY (DR ABC)
 A rapid patient assessment to determine the presence of any
immediate life-threatening injuries or conditions.

 Major goal of the primary survey is to check for life-threatening

problems to the airway, breathing, and circulation.

DANGER – check for danger

• Assess the situation
• Are there any risks/danger to you, casualty and bystanders?
• Put your safety first and deal with any danger
RESPONSE – try to get a response
• Assess the casualty
• Is the casualty conscious?
• Does he respond to questions and to gentle
shaking or tapping?
• If person respond, ask consent to treat casualty
• If person does not respond, call for advanced
medical help
AIRWAY – open the airway
First priority is to establish and maintain an open
passage for air to enter and leave the lungs.
• head-tilt chin-lift (non-trauma)
 Head-tilt/Chin-lift Maneuver

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• Jaw thrust (trauma)
 Jaw-thrust Maneuver

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BREATHING – check for breathing

• Look along the body to see if the chest is

moving up and down.
• Feel for breath on your cheek.
• Listen for breathing. Put your ear close to
unconscious person’s mouth and nose.
CIRCULATION
• check for a pulse, look for obvious bleeding and
control it.
• For an unconscious casualty who is
unresponsive and who is not breathing
normally, commence CPR
 SECONDARY SURVEY
The purpose of the secondary survey is to perform a rapid
but complete patient assessment. The secondary survey
should not take longer than 10 minutes.

• Vital signs
• History taking
- Chief complaint(s) and history of current injury or illness
- Allergies
- Medications
- Past medical history
• Head-to-toe examination
 CONDUCTING THE SECONDARY SURVEY
• The secondary survey is a closer look at the victim
once life-threatening conditions are controlled and
vital signs are recorded.
• Conduct a full-body inspection of the victim. Use
your senses to collect additional information.
• Explain your actions. Speak calmly. Keep the victim’s
head and neck aligned.

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 CONDUCTING THE SECONDARY SURVEY
• Look for deformities, wounds, bleeding,
discoloration, penetrations, neck openings, unusual
chest movement.
• Listen for unusual breathings, sounds, or sensations.
• Feel for unusual masses, swelling, hardness, stiffness,
muscle spasms, pulsations, tenderness, temperature.
• Smell for unusual odors on the victim’s breath, body,
or clothes.

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 SECONDARY SURVEY
Interview casualty
• His or her name.
• What happened (mechanism of injury).
• If he or she feels pain anywhere.
• SAMPLE (sign and symptom, allergies,
medications, past medical history, last meal,
events preceding).
• About pain-PQRST (provokes, quality,
region/radiates, severity, time).
Check vital signs
• Level of consciousness
• Pulse
• Breathing
• Skin appearance and
temperature
• Pupils

Do a head-to-toe examination
 Levels Of Consciousness
A casualty may experience different levels of
consciousness.

• Person is alert (A).

• Responds to verbal stimuli (V).
• Responds to painful stimuli (P).
• Is unconscious (U).
 Pulse

• Locate pulse site.

• Determine pulse rate
• Determine if pulse is regular or irregular.
 Breathing
Determine breathing rate.
• Note breathing rate or whether the person is
gasping for air.
• Making unusual noises as he / she breathes.
• Breathing excessively fast or slow.
• Experiencing pain when breathing.
 Pupils
• Examine the patient’s pupils, especially if a head injury is
suspected.

• The pupils are normally round and are equal to each other in
diameter. In light, they each constrict (their diameter gets
smaller). In darkness, they dilate (their diameter gets larger).

• Examine both eyes and determine if the pupils are constricted,

normal, or dilated, and whether they are equal to each other
in size – shining a bright light into one eye normally causes
both pupils to constrict equally. Once the light is removed, the
pupils both dilate back to their previous size.
 Skin
• Feel person's forehead with back of your
hand.
• Look at person's face and lips.
• Note if skin is
Cold or hot
Unusually wet or dry.
Pale, bluish, or flushed.
 Head-to-Toe Examination
• The general approach to the head-to-toe physical
examination is inspection and palpation (i.e., look
and feel), starting with the head and proceeding
down through the various regions: neck, chest,
abdomen, pelvis, back, and extremities.
 SEQUENCE OF THE SECONDARY SURVEY

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 PRIMARY AND SECONDARY SURVEYS

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THANK YOU