Chapter 4
Finding Out What’s Wrong
Victim Assessment Overview (1 of 2)
• Knowing what to do and what not to do is
crucial during an emergency.
• A victim assessment is a sequence of
actions that helps determine what is
wrong.
• A primary check will determine if:
• there is illness or injury.
• whether the victim is responsive or
unresponsive.
• if a life-threatening condition exists.
Victim Assessment Overview (2 of 2)
Assessment Steps
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Scene size-up
Primary check
Secondary check
SAMPLE history
Reassessment
Scene Size-Up
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Look for hazards.
Notice the potential for violence.
Be observant of weapons.
Reduce exposure to potentially
dangerous body substances.
• Determine whether the problem is
an injury or an illness .
Primary Check (1 of 2)
Identify life-threatening conditions
so that you can immediately take
action to treat the conditions.
•Responsiveness
•Circulation
•Breathing
•Severe bleeding
Primary Check (2 of 2)
Form a first impression.
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Injury or illness?
Responsive or unresponsive?
Breathing adequately?
Talking?
Bleeding?
Chance of exposure to blood or body fluids?
Danger to you, victim, or bystanders?
Check Responsiveness
• Tap the victim on
the shoulder and
ask, “Are you
okay?”
• Use the AVPU
scale.
Alert Victim
• Evaluate ability to remember.
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What is your name?
Do you know where you are?
What are the month and year?
What happened?
An Unresponsive Victim RAP-CAB
(1 of 4)
R = Responsive?
Tap shoulder and
shout, “Are you
okay?”
Courtesy of Berta A. Daniels, 2010
An Unresponsive Victim RAP-CAB
(2 of 4)
A = Activate
emergency medical
services (EMS)
Courtesy of Berta A. Daniels, 2010
An Unresponsive Victim RAP-CAB
(3 of 4)
P = Position the
victim on his or her
back.
C = Cardiopulmonary
resuscitation (CPR)
Start with 30 chest
compressions if the
victim is not breathing.
Courtesy of Berta A. Daniels, 2010
An Unresponsive Victim RAP-CAB
(4 of 4)
A = Airway
Open the airway.
B = Breaths
Give two breaths and
continue CPR.
Courtesy of Berta A. Daniels, 2010
A Responsive Victim
RAP-ABC
R = Responsiveness
A = Activate EMS
P = Position
A = Airway
B = Breathing
C = Circulation
Check for Breathing
• Chest movement
• Normal and
abnormal breath
sounds
• Feeling adequate
air movement
Check for Severe Bleeding
• Check for a large amount of blood.
• Around the victim
• On the victim’s clothing
• Control bleeding.
• Wear exam gloves.
Position the Victim
Most victims should not be moved.
•Exceptions:
• Unsafe location
• Victim is face down and needs CPR.
• Victim has difficulty breathing from vomit or
secretions.
• First aider is alone and must leave to get
help.
High Arm IN Endangered Spine
(HAINES) (1 of 2)
• Keep left arm straight, extended above
the head with upper part of the arm next
to the head.
• Bring right arm across the chest.
• Place back of right hand against the left
cheek and hold it there.
High Arm IN Endangered Spine
(HAINES) (2 of 2)
• Bend the far leg at the knee and pull the
bent leg to roll the victim toward you.
• Head stays on left arm while rolling.
• Right hand stabilizes the head.
• Right bent knee prevents rolling.
Left Side Advantages
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Keeps the airway open
Delays vomiting
Delays a poison’s effect
Relieves pressure on a pregnant
woman’s vena cava
Secondary Check (1 of 2)
• Determine whether
the cause or
mechanism of
injury was
significant.
• Assume a victim
with a head injury
also has a spinal
injury.
Secondary Check (2 of 2)
• For a responsive victim:
• Ask if he or she can feel or wiggle the
fingers and toes.
• For an unresponsive victim:
• Check spinal cord with Babinski reflex test.
Signs and Symptoms
Signs
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See
Feel
Hear
Smell
Symptoms
• Things the victim
feels
• Things the victim
can describe
• Chief complaint
DOTS
D = Deformity
O = Open wounds
T = Tenderness
S = Swelling
© Johnathan Noden-Wilkinson/ShutterStock, Inc.
Significant Cause of Injury (1 of 5)
• Check the head.
• Check eyes
(PERRL).
• Check the ears.
• Check the nose.
• Check the mouth.
Significant Cause of Injury (2 of 5)
• Check the neck.
• Check the chest.
• Gently press
inward.
Significant Cause of Injury (3 of 5)
• Check the
abdomen.
• Gently press on
all four quadrants.
Significant Cause of Injury (4 of 5)
• Check pelvis.
• Gently press
downward on
tops of hips.
• Press downward.
Significant Cause of Injury (5 of 5)
• Check
extremities.
• Circulation
• Sensation
• Movement
• Check back.
Special Considerations (1 of 4)
• Skin condition
• Color
• Temperature
• Moisture
Special Considerations (2 of 4)
• Capillary refill test
• Press fingernail or
toenail for a few
seconds and
release.
Special Considerations (3 of 4)
• Expose injury.
• Explain what you
are doing.
• Maintain privacy.
• Prevent exposure
to cold.
Special Considerations (4 of 4)
• Check the following for
medical identification tags:
Courtesy of the MedicAlert Foundation ®
Courtesy of the MedicAlert Foundation ®
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Wallet
Purse
Necklace
Bracelet
SAMPLE History
Recheck
• Serious illness or injury: every 15
minutes
• Unresponsive victim: at least every 5
minutes
Triage
Process of prioritizing multiple
victims
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Immediate care
Delayed care
“Walking wounded”
Dead