Chapter 3

Victim Assessment and Urgent Care

Lesson Objectives

• Explain the importance of performing a detailed and systematic assessment.

• List what to look for during the scene survey.

• Identify and describe the steps of the initial assessment.

• Use the SAMPLE mnemonic to obtain a victim’s history.

• Assess a victim’s vital signs and perform a physical exam.

• Know how to perform ongoing assessment of a victim.

• Know how to handle multiple-victim incidents (ie, triage).

Assessment (1 of 2)

• Perform a rapid, accurate assessment.

• Skills must be learned well and practiced regularly.

Assessment (2 of 2)

• Five-part victim assessment:– Scene survey– Initial assessment– Victim’s history– Vital signs and physical exam– Ongoing assessment

Scene Survey (1 of 2)

• Provides first impression and reveals hazards

• Protect yourself from blood or bodily fluids.

Scene Survey (2 of 2)

• What to look for– What is cause of condition and related

problems?– Is the scene safe?– Is the victim injured or ill?– What is the mechanism of injury?– Is the victim responsive or unresponsive?– How many victims are there?

Initial Assessment (1 of 4)

• Initial assessment is designed to detect life-threatening conditions.

• Determine if the victim is responsive or unresponsive.

• If unresponsive, prepare to evacuate.

• Assess breathing problems and bleeding; attend to these problems before proceeding further.

Initial Assessment (2 of 4)

• Assess the airway– If responsive person

cannot speak or cough, treat for obstructed airway.

– What to do: Open airway using head tilt–chin lift maneuver.

Initial Assessment (3 of 4)

• Assess breathing– Determine whether victim is breathing normally

and adequately.– Look, listen, and feel for movement of air.– What to do:– Recovery position– Rescue breathing

Initial Assessment (4 of 4)

• Check for hemorrhage – Severe bleeding,

external or internal, can be life threatening.

– Check entire body for blood.

– Expose affected area.

– Apply direct pressure.

Victim’s History (1 of 2)

• Use SAMPLE mnemonic to remember steps in obtaining history.

• If victim cannot provide history, obtain it from companions.

• Check for a medical identification tag.

Victim’s History (2 of 2)

• SAMPLE mnemonic– Symptoms

– Allergies

– Medications

– Past relevant medical history

– Last oral intake

– Events leading up to the injury or illness

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Vital Signs and Physical Exam (1 of 9)

• Assess level of responsiveness, pulse, breathing, body temperature, skin condition.

• Check vital signs at the start of physical exam.• Assess vital signs frequently for unstable victims.

Vital Signs and Physical Exam (2 of 9)

• Level of responsiveness: AVPU scaleA = Alert

V = Responds to verbal stimuli

P = Responds to painful stimuli

U = Unresponsive to voice or pain

Vital Signs and Physical Exam (3 of 9)

• Pulse– Radial pulse– Practice until you

can find pulse easily and quickly.

Vital Signs and Physical Exam (4 of 9)

• Breathing– Snoring– Stridor– Wheezing– Gurgling– Rattling

Vital Signs and Physical Exam (5 of 9)

• Temperature– Can alert you to fever, heat illness, or

hypothermia.– Carry a thermometer in your first aid kit.– Estimate body temperature by placing the back

of your hand on the victim’s forehead.

Vital Signs and Physical Exam (6 of 9)

• Skin condition– Color and temperature– Moisture

Vital Signs and Physical Exam (7 of 9)

• Physical examination – Perform a thorough, systematic physical

assessment.– Victims with minor injuries or illnesses might

not require a complete physical assessment.

Vital Signs and Physical Exam (8 of 9)

• Physical examination – DOTS mnemonic:

D = Deformities

O = Open wounds

T = Tenderness

S = Swelling

Vital Signs and Physical Exam (9 of 9)

• Physical examination – After the physical exam

• You should have a good idea of what is wrong with the victim.

• Suspect a spinal injury in any unresponsive person injured in a high-velocity episode.

Ongoing Assessment

• Used to monitor victim’s condition.• Determine whether victim’s condition is

staying the same.• Reassess:

– Breathing, mental status, vital signs– Every 5 minutes for unstable victims– Every 15 minutes for stable victims

• Monitor results of first aid care.

Multiple-Victim Incidents (Triage) (1 of 2)

• Emergency situations with two or more victims• Decide who to care for and evacuate first.• Tell mobile victims to move to specific area.

These victims are in lowest-priority category.• Find highest priority victims by performing

assessment on remaining victims. Go to motionless victims first.

• Spend fewer than 60 seconds with each victim.

Multiple-Victim Incidents (Triage) (2 of 2)

• Triage categories: – Highest priority– Second priority– Lowest priority