CPD ArticleISSUE 60

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Assessing the sick or injuredAims and Objectives:

This article aims to show you how one should deal with a sudden injury or illness by informing you of the three stages of assessment you must undertake if an injury/ illness occurs. As well as this, it aims to tell you how to understand what has happened in an accident in order to determine the mechanisms of injury so you can figure out the severity and type of any injuries which may have been sustained.

Learning Outcomes:

• Learn the ABC principle • Know how to perform a primary and secondary

assessment • Understand how to check the level of response of a

casualty • Understand the importance of knowing the

circumstances of an accident so you can predict the severity ad type of any sustained injuries

This learning session has been judged as being equivalent to one

hour of verifiable CPD. To claim your verifiable CPD you will need to

answer the questions at the end of this article and submit them either

by email to secretary@bidst.org or by post to the BIDST Membership

Office 44-46 Wollaton Road, Beeston Nottingham NG9 2NR. You will

also need to keep a copy of the article together with your feedback

sheet and certificate for revalidation. 1 HrVerifiable CPD

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If a sudden injury or illness occurs, it’s important for you to take responsibility for making assessments regarding its severity. Don’t deal with any casualties until you have assessed the overall situation, ensured that everyone is safe, and have organised any necessary help required. When dealing with a sudden injury/illness, it is important to remember to: be safe; be aware of risks; build and maintain the trust of the casualty; call appropriate help; remember your own needs.

When managing a sick or injured person, there are three things you need to remember to do:

1. Find out what’s wrong with the casualty

2. Treat their conditions in order of severity

3. Arrange for the next step of their care. This will include deciding what type of care the casualty needs, whether it be calling for emergency help, seeking medical advice, or allowing them to go home (possibly accompanied, if needs be). Other people can be of assistance with this, as they can call 999/112 whilst you check the casualty, or may be able to support the casualty.

When you assess a casualty, there are three methods of assessment you need to undertake. Firstly, you need to do the primary survey, in which your aim is to identify and treat any life threatening conditions or injuries. If a casualty is conscious, speaking, and suffering from few minor injuries, the primary assessment will not take long. However, if

a casualty is harmed more severely, then the assessment will take longer. When undertaking the primary survey, you must follow the ABC principle: Airway, Breathing, and Circulation.

When checking the airway, you must see if the airway is open and clear. If the casualty is speaking, then the airway is open and clear; if it is not, the casualty will not be able to speak. If the airway is obstructed, the casualty will be unable to breath, resulting in hypoxia and death.

When checking breathing, one should check that the casualty is breathing normally. If this is not the case, call 999/112 for emergency help, and perform CPR immediately. If the casualty is breathing, however, check for and treat any breathing difficulty, such as asthma.

Finally, check the circulation of the casualty: if they are bleeding severely, they must be treated immediately, as this can otherwise lead to a life threatening condition called shock. Call 999/112 for emergency help. If there is no bleeding, continue to the second method of assessment: the secondary survey.

The secondary survey is a detailed examination of a casualty to look for injuries or conditions which may not be immediately apparent by carrying out a head-to-toe examination. When doing this, your aims are to find out: history (what actually happened, and any relevant medical history), symptoms (injuries or abnormalities the casualty tells you about), and signs (injuries or abnormalities you can see). Record your findings, and pass on any relevant information to a medical team should one be required.

After doing the first two assessments, you should check the casualty’s level of response. You will have previously noted whether or not the casualty is conscious, however you need to distinguish the level of response using the AVPU scale (is the casualty Alert? Do they respond to Voice? Do they respond to Pain? Are they Unresponsive?). This is important as some illnesses/injuries can cause deterioration in the level of response, and so it’s vital that you assess response level and monitor any changes.

Mechanisms of injury, such as the circumstances of injury and forces exerted onto the body, determine the type and number of injuries sustained. This means that a history of the incident and the injury mechanism is important, as it provides information which helps determine the type and severity of the injury, and therefore the treatment required, to those who help the casualty.

Knowing the circumstances of an injury can help to determine the type and severity of the injury, and can also be used to predict treatment options and the outcomes for the casualty. For example, should a car accident occur, medics will know that a casualty is more likely to sustain a serious injury if the collision was side-on rather than frontal. This is because the side of the

car provides less protection for the casualty as it cannot absorb as much energy as the front. As well as this, if a casualty was wearing a seatbelt and was struck from wither the front or the back, a specific injury pattern can be predicted as a result of the body’s propulsion one way whilst the head is propelled in the opposite direction, an occurrence known as whiplash.

The energy forces which are exerted on the body during an impact are another important indicator of the type and severity of an injury. For example, if a casualty falls from a short distance, such as 1 metre, they will be unlikely to suffer much more than bruising; however, if they fall from a height of more than 2 metres then more serious injuries are likely to occur, such as pelvic fractures or internal bleeding. Less serious falls may also mask more dangerous injuries, as someone may unknowingly sustain head or spine injuries as a result of their fall.

When you are attending to a casualty, it is important to ask the casualty and any witnesses questions to determine the mechanisms of injury. Possible questions include:

• What happened?

• How did it happen?

• How did the casualty fall?

• How far did they fall?

• What type of surface did they land on?

• Did the body make contact with a solid object such as the floor, a dashboard etc?

• Was the casualty wearing a seatbelt?

• Were they ejected from a vehicle?

• Did the vehicle roll over?

• Was the casualty wearing a helmet?

CPD Questions

Q1.) What do you need to remember to do when managing a sick or injured person?

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Q2.) What is your overall aim in the primary survey?

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Q3.) What does the ABC stand for in the ABC principle?

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Q4.) What is the secondary survey?

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Q5.) What are the three things you are looking to find out about in the secondary survey?

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Q6.) What do you use to distinguish the casualty’s level of response, and what does the acronym stand for?

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Q7.) What do mechanisms of injury determine?

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Q8.) Why is knowing about the circumstances of an injury important?

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Q9.) What should you make sure to do when attending to a casualty?

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“To claim your verifiable CPD you will need to answer these questions and submit them either by email to secretary@bidst.org or by post to the BIDST Membership Office 44-46 Wollaton Road, Beeston Nottingham NG9 2NR. You will also need to keep a copy of the article together with your feedback sheet and certificate for revalidation”.

44-46 Wollaton Road, Beeston, Nottingham NG9 2NRTelephone: +44(0)115 968 3181 Fax: +44(0)115 925 4800 Website: www.bidst.org Email: secretary@bidst.org

Name: _______________________________________ GDC Number: _________________________________

Address: _____________________________________________________________________________________

Postcode: ____________________________________ Telephone no: _________________________________

Signed: ______________________________________ Date: _________________________________________