WILDERNESS FIRST AID
Patient Assessment
Brent McKelvey, EMT-I
Establishing Patient Rapport
• Patients will form an opinion of you within
the first few minutes, if not seconds of
meeting you.
– This includes how you…
• Act
• Dress
• Talk
• Establishing good patient rapport is
essential to obtaining a good patient
history and assessment.
Introducing Yourself
• “Hi, my name is ______. I’m trained in
wilderness first aid and I’m here to help
you today. Can I help? What seems to be
the problem?” This also gives you
permission to help the patient.
• Eye contact, eye level
• Be aware of body language
Asking Questions
• Use the patient’s name when possible.
• Open-Ended Questions:
– Where do you hurt?
– Can you describe your pain?
– What medical conditions do you have?
• Closed-Ended Questions:
– When did you pain start?
– Is your pain sharp and shooting, or is it a dull and
aching pain?
– Are you cold?
First Aid Report Form
• Every space needs to
be filled.
• If it is not documented,
it was not done.
• It is important to
document because you
can easily forget things
in an urgent situation.
Scene Size-Up
• Body Substance Isolation (BSI)
Gloves, Eye Protection…
• Scene Safety
#1=You #2=Other Responders
#3=Your Patient #4=Any Bystanders
• Number and Location of Patients
• Mechanism of Injury / Nature of Illness
• Consider S-Spine
Initial Assessment (1 of 2)
• Overall general impression can give you a lot of
information about a scene.
• AVPU
– Alert
• Patient is able to answer questions appropriately. Patient
should be able to answer questions about person, place, time
and event.
– Verbal
• Patient responds to verbal stimulus.
– Painful
• Patient responds to painful stimulus only such as pinching
the earlobe or pinching the skin above the shoulder.
– Unresponsive
• Self Explanatory
Initial Assessment (2 of 2)
• Airway
– Head-Tilt, Chin-Lift or Jaw-Thrust if suspected
head, neck or back injury.
– Ensure a clear airway. Be aware of the
tongue and any vomit.
• Breathing
– Look, Listen and Feel
• Circulation
– Radial or Carotid Pulse
SAMPLE History
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Signs and Symptoms
Allergies
Medications
Pertinent past history
Last oral intake
Events leading up to the accident
Signs and Symptoms
• Signs are conditions you can see, such as
a bruise or laceration.
• Symptoms are what the patient feels and
tells you about, as in “My head hurts.”
Allergies
• Allergies to medicine.
– Morphine, “sulfa” drugs, the “caine” drugs…
ex: lidocaine
• Allergies to natural products.
– Wheat, eggs, pollen…
• NKDA – No Known Diagnosed Allergies
Medications
• Try to obtain all the patient’s medications.
This includes prescriptions, over the
counter drugs, narcotics and street drugs.
• A complete list of drugs can help you
figure out what medical conditions a
patient has. Ex: Lantus is insulin used for
the maintenance of diabetes.
Pertinent Past History
• A patient's medical history is a valuable
tool in identifying or diagnosing a medical
condition.
• A medical condition could be the cause of
a traumatic problem. Ex: A patient had a
seizure and falls into a creek.
Last Oral Intake
• When was the last time the patient had
anything to eat or drink.
• This can be especially useful with diabetic
patients showing signs of altered mental
status that have not had anything to eat in
a while.
Events Leading Up To The
Accident
• What was happening the moment before
the accident happened.
• Having a clear history of symptom onset or
how an injury occurred helps in identifying
possible life-threatening conditions.
OPQRST
• Onset- What was happening when your
pain/problem began?
• Provocation- Does anything make your pain
better or worse?
• Quality- How would you describe your pain?
• Region/Radiation- Where is your pain and does
it radiate anywhere?
• Severity- Can you rate your pain on a scale from
1-10?
• Time- When did the problem begin?
Physical Exam
• DOTS
– Depressions
– Obvious Deformity
– Tenderness
– Swelling
• DCAP-BTLS
– Deformities - Burns
– Contusions - Tenderness
OR
– Abrasions - Lacerations
– Penetrations - Swelling
• Inspection, Auscultation, Palpation…
-Or• Look, Listen and Feel…
• Medical Tags.
General Principles of the Physical Exam
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Do no further harm.
Be complete and systematic.
Use direct observations.
Compare body parts.
One person does the exam.
Make multiple observations.
Record all your findings.
Do entire exam first and then go back and render
first aid unless it is an urgent patient.
• Do not move patient unless there is a safety issue.
Head
Start at the top of the head. Palpate the scalp
and top of the skull. You are looking for cuts,
lumps, depressions, 'soft' spots, and unstable
segments of skull. Inspect the back of the scalp
and skull, to the extent that C-spine
immobilization will allow. Inspect the ears,
looking for blood, or cerebral spinal
fluid. Inspect the eyes, looking for discoloration,
irregular or unequal pupils. Using a light source,
check for "pupil response." Check the nose for
irregular shape or discharge of any blood or
fluid.
Neck
Check the neck. Re-palpate the carotid
pulse. Record the findings. Inspect the
neck for bleeding, bruising, or the
presence of a stoma.
Chest
Check the chest. Inspect the surface for
blood, holes, bruises and unstable
segments. Check for symmetrical rise and
fall of the chest with each respiration, by
placing the heels of your hands on the
lower border of the rib cage. Both of your
hands should rise and fall with the chest,
symmetrically.
Abdomen
Check the abdomen. Inspect for blood,
and evisceration. Palpate for lumps,
rigidity and guarding, checking one
quadrant of the abdomen at a time.
Pelvis
Check the pelvis. First one side then the
other. Palpate each hip checking for
instability. Inspect each half of the pelvis,
looking for blood or bruising. Check the
pelvis as a unit for stability by placing your
hands on either side of the pelvis and
pushing up and down gently. Look, listen
and feel for crepitus (grinding of two bones
together.)
Extremities
Check the extremities, upper and lower, one at a
time. Wrap your hands around the limb and
palpate away from the body. Look for blood as
you do so. Palpate for lumps, and obvious
inconsistencies in bone structure. Ask the
patient to squeeze your hand with theirs or push
against your hand with their foot. Check pulses
on the hand and foot. Cover the hand or foot
and squeeze the finger or toe to test for sensory
function.
Back
Check the spine. Slide a gloved hand
under the patient, palpating the spine for
any spinal abnormalities. Withdraw the
gloved hand and inspect the glove for
blood.
Vital Signs
• Check every 5 minutes on a severely
injured patient or every 15 minutes on a
non-severely injured patient.
• Pulse
• Breathing
• Blood Pressure (not part of this class)
• Skin Condition
• Pupils
Pulse
• Normally 60-100
• Take note of rate, rhythm, and quality…
– Rate: Numerical Value
– Rhythm: Regular or Irregular
– Quality: Strong or Bounding, Weak or Thready
• Palpate pulses using two fingers and not your
thumb.
• Pulse sites include: The radial pulse in the wrist,
brachial pulse in arm, carotid artery in the neck,
femoral pulse in the thigh, dorsalis pedis in the
foot, and the tibialis posterior in the ankle.
Breathing
• Normally 12-20
• Take note of rate, rhythm, and quality…
– Rate: Numerical Value
– Rhythm: Regular or Irregular
– Quality: Deep or Shallow
• Note any sounds associated with
breathing: ex: gurgling, wheezing…
Blood Pressure
• Normally 120/80
• Systolic/Diastolic
• A systolic pressure of 100 is needed in
most patients to perfuse vital organs.
Skin Condition
• Normally pink, warm, and dry.
• Take note of skin color, temperature, and
condition.
– Color: Pink tint, Ashen, Pale or Bluish
– Temperature: Warm or Cool
– Condition: Damp, dry, clammy…
Pupils
• Normally equal, round and reactive to
light. (PERRL)
• They should not be different sizes or
sluggish to respond to light.
• To test pupils, shade eye with cupped
hand then expose to light.
Dilated Pupils
Constricted Pupils
START Triage Background
• Simple Triage And Rapid Treatment
• Developed by Hoag Hospital and the Newport Beach
Fire Department.
• The whole process should take less than 60 seconds per
patient.
• The concept of triage is simply a method of quickly
identifying victims who have immediately life-threatening
injuries AND who have the best chance of surviving so
that when additional rescuers arrive on scene, they are
directed first to those patients.
• If you are the initial START rescuer, you DO NOT stop to
do other than the most basic intervention. If you attempt
to treat every patient before completing the triage, you
cannot assess the rest of the patients and identify the
top priorities.
Start Triage
Three things to look at:
“RPM”
•Respirations
•Over 30?
•Pulse
•Radial Pulse
Present?
•Mental Status
•Follow Simple
Commands?
• GREEN
– “Walking Wounded” or
Minor
• YELLOW
– Delayed Care
• RED
– Immediate Care
• BLACK
– Deceased
Example START Triage Scenario
www.citmt.org
START Triage Flow Chart
www.citmt.org
Example #1
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Can walk- No
Respirations- 22
Respirations after repositioning- N/A
Radial Pulse- Yes
Can follow simple commands- Yes
Delayed
Example #2
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Can walk- No
Respirations- 0
Respirations after repositioning- 36
Radial Pulse- Yes
Can follow simple commands- Yes
Immediate
Example #3
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Can walk- Yes
Respirations- 24
Respirations after repositioning- N/A
Radial Pulse- Yes
Can follow simple commands- Yes
Minor
Example #4
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Can walk- No
Respirations- 0
Respirations after repositioning- 0
Radial Pulse- Can’t Find
Can follow simple commands- No
Deceased
Example #5
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Can walk- No
Respirations- 14
Respirations after repositioning- N/A
Radial Pulse- No
Can follow simple commands- Yes
Immediate
Example #6
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Can walk- No
Respirations- 24
Respirations after repositioning- N/A
Radial Pulse- Yes
Can follow simple commands- No
Immediate
Putting It All Together
• Use everything gathered from your patient
history and assessment to base your
patient treatment on.
• By taking a through patient assessment
you will be able to identify all patient
injuries.
• Remember to document all your findings
on the first-aid report form.
• Do no further harm.