- Be systematic
- Think out loud
- Reassess when there is a change
- Note down your findings if you can
As you are walking towards the injured practitioner, look at the scene and think through what happened during the accident. This is called the ‘mechanism of injury’ and thinking about it will help direct your attentions during the casualty assessment. For example, did they land on their head, their legs or their back? This also allows you to check for danger to you or the rescuers. Could what just happened to them happen to you or the group?
Being systematic in your assessment is most important thing, so we use the mnemonic DRcABC to keep us on track. The key question you are asking when assessing each component is ‘is it normal?’:
D – Danger: are you, the rescuers or the casualty in danger of further injury? If so, either do not approach the casualty or move them to a safer place.
R – Response: when you arrive at the pilot, gently squeeze their shoulder, call their name and ask ‘can I help?’. This also ensures you have consent for your assessment and treatment.
c – Catastrophic Haemorrhage: in severe extreme sports trauma, the biggest risk to the casualty is bleeding. It is even more of a pressing problem than a closed airway. If you see a source of major blood loss, quickly attempt to staunch it before continuing your assessment.
A – Airway: open and assess the airway.
B – Look at their breathing rate (normally 12-18 breaths per minute in an adult), breathing pattern and symmetry and for any injuries to the chest wall. Ask yourself each time ‘does it look normal?’
C – Look for obvious bleeding, bruising or injury, feel the pulse in their neck for the rate (should be between 60-100 beats per minute), feel their skin (cold, sweaty and clammy are signs of possible blood loss).
When looking for these key parameters, be thorough and systematic. Try not to zone in on the one area that is obviously injured and potentially miss other crucial findings. Look under clothes if possible but remember to keep the casualty warm and to protect their dignity.
If you can, think about gathering the following ‘AMPLE’ information for the rescue services:
A – Allergies
M – Medications
P – Past illnesses and injuries
L – (time of) Last meal
E – Events leading up to the accident
Assessment is a dynamic process. Keep reassessing and talking to the casualty. Think out loud so people can hear your assessment but try not to ‘talk over’ the casualty. Always be compassionate and reassuring. Be particularly sensitive when describing severe injuries but don’t try to conceal anything from the casualty: they will already know that they have been hurt, so will respond better to calm, kind but direct communication.