Plan & Prepare

Traumatic Injuries

When you encounter a traumatic injury, the impact of an outside force can cause varying types of damage to the human body. Before any first aid can be given, an assessment must be made in an orderly process to ensure that both those providing care and the person in need are kept safe and any problems are correctly identified.

It is natural to get tunnel vision when seeing someone who is sick or injured. First, don’t just do something, stand there. Rushing to provide care without an orderly assessment of the scene may inadvertently turn the rescuer into a victim. The initial assessment should consider hazards that could cause immediate injuries to those attempting to assist the injured person.

A systematic approach to the problem will allow a logical step-by-step assessment, stabilization, options for treatment, and eventually a decision on whether the person needs to leave the outdoor setting to seek medical help, or can stay and continue on with the adventure.

Symptoms and Description

Ensure it is safe for the rescuer to approach the person in need. Have situational awareness to consider applicable issues that may have caused the injury or potentially lead to complications.

Consider scene safety, are there exposed ledges, rock fall, falling tree limbs, wild animal attacks, uphill landslide or avalanche, stormy or excessively hot weather?
Consider the number of people who need help.
Consider potential mechanism of Injury. Questions to ask yourself: how do you think they were injured, what may have been hurt, and if someone suffered a bad fall, did they injure their spine?
Take necessary precautions to protect yourself. If body substances are present, consider gloves and / or eye protection precautions prior to involvement protect both you and the injured person.
If multiple victims are encountered, assessing the entire scene and determining where you can do the most good to the most people should dictate your priority (For example, you may need to improvise and apply a tourniquet to a heavily bleeding limb before you check the breathing on a non-responsive person).

Defining the Risk Category

The Primary Assessment

After the scene has been assessed and you are certain it is safe to approach, the next step is to identify immediate threats to life, this is called the “primary assessment.” The primary assessment works to identify potential causes of death, including lack of oxygen from a blocked airway (by a tongue or foreign object), or inadequate breathing, blood loss (either internal or external), or damage to the brain or spinal cord. If a problem is found during the primary assessment, stop and recognize it, and stabilize it if possible, before moving on.

If there is a patient who has a decreased level of responsiveness and cannot verbally respond, this makes things challenging, but a calm and systematic approach will be helpful.
If there is bleeding, stop the bleed.
Check for breathing and breathing pattern, as gasping respirations often show a poor breathing pattern that may require CPR.
If the person cannot move or feel their arms or legs equally, there may be concern for an injury to the spinal cord and it may be necessary to take necessary spinal immobilization precautions.

Secondary Assessment

Once evaluation of any immediate life-threatening injuries is complete, the “secondary assessment” will now determine if other less obvious injuries can be identified. Be prepared to perform a comprehensive and focused assessment of all the injuries. This secondary assessment will involve gathering a complete history and performing a thorough physical exam from head to toe in a systematic manner. Ask about the symptoms, duration, frequency, severity, exacerbating or improving factors.

The secondary assessment should be thorough, with direct and simple questions. Pushing everywhere may elicit subtle areas of tenderness.
The outcome of this secondary assessment will lead to system specific problems and decisions for treatment and / or evacuation to definitive medical care.
It is reasonable to start at the head and work down towards the feet. Always let the person know what you are doing and ask permission before examining them so they are not alarmed or offended. While performing the secondary survey, move the patient as little as possible to avoid aggravating any injuries.

Physical Exam: Ask the person where it hurts, and then, when feeling gently, ask if it hurts to be touched there. You may need to remove clothing to completely visualize and understand the extent of an injury.

Head. Feel the skull for swelling and bruising, look for drainage from the ears, nose, and mouth. Have the patient clench their teeth to ensure they match up, and can open and close their jaw naturally and without pain.
Back. Differentiate midline spinal tenderness from non-midline tense muscles and tenderness that represent the difference between a broken bone and muscle spasm. Press on every bone from the top to the bottom of the spine. Ensure the person is rolled as a single unit to ensure as little neck angulation or side-to-side movement as possible.
Chest. Press on both sides of the chest for tenderness, listen for wheezing, gurgling, or abnormal breath sounds or abnormal breathing pattern.
Abdomen. Press on all quadrants of the abdomen to differentiate pain from tenderness.
Pelvis. Gently push on the bony prominences of the pelvic at the hips. If there is exquisite pain on pushing this site, consider a traumatic injury.
Arms. Feel and look for symmetry and full range of movement. Press on one arm at a time, and ensure to check wrists, hands, and fingers.
Legs. Feel and look for symmetry and full range of movement.

History: Oftentimes the history of how a person is feeling may offer more insight than a physical exam. Defining how a person is feeling (the symptoms) often provides an answer to whether they can stay outside and continue on with their adventure, or have to seek medical advice or even evacuate for further medical evaluation and care.

Guidelines

Collect information and write it down as soon as possible. Document what you do and any changes to the person that is being helped. This is important for both patient care and to protect the first-aid responder. If the patient requires evacuation, this note will allow for a continuation of care and concise communication of the events that transpired in the pre-hospital setting.

Summary of the age, complaints, and occurrences.
Observations of what was found on the primary and secondary survey.
Assessments of what may be wrong, and assess any changes that have occurred over time.
Plan what needs to be done next.