Taking Action In An

Emergency:
Initial Assessment

You have just arrived at the
site of an emergency.

What should you do first?
Step 1: Survey The Scene
(check the scene)
Piece together the puzzle
Look for dangerous hazards
Quickly determine:
The number of victims
The cause of injury
Are there witnesses?
Survey The Scene #2
Do not approach the victim if
threat exists
Survey The Scene #3
Attain consent
Gain victims confidence
Identify problems
Dont assume that the injury
you see is the only one
Gather info that will be helpful
to EMS
Survey The Scene #4
Remain calm
Call EMS if needed
Do not move the victim
unless it is necessary to
support life or life threat
exists
Step 2: The Initial Victim
Assessment
Identify and correct life threatening
conditions related to
Airway
Breathing
Circulation
Disablity
Goal of the Initial Assessment
To assess heart, lung, brain and
spinal cord functioning (address life
support does the victim need
CPR?)
Cardio Pulmonary Resuscitation
Cardio refers to heart
Pulmonary refers to lungs
Resuscitate refers to revival
How To Proceed Through The
Initial Assessment:
RAPABCD
R - check for responsiveness
A alert
V responds to voice
P responds to pain
U unconscious, no responses
A - activate EMS (911)
P - position victim on the back
How To Proceed #2:
RAP ABCD
(checking for vital signs - pulse
and respiration)
A - Airway
B - Breathing
C - Circulation
D disability
Airway
Open the airway by head tilt, chin
lift
If spinal cord injury is suspected, be
more cautious
Breathing
Look, listen, and feel for breathing
(no more than 10 seconds)
Circulation
Check for major bleeding

No longer required to check for
pulse
Secondary Assessment:
History and Physical Exam

Head to toe for major injury
or unresponsive
Minor injury, examine
complaint only
More regarding head to toe
exam will follow
The Secondary Assessment
Identify yourself
Obtain consent
Ask and use the victims name
Ask about chief complaint
Use SAMPLE to help you
remember questions to ask the
victim
Questions To Ask:
SAMPLE
S - symptoms
symptom: something the victim
tells the first aider
sign: something the first aider
sees, hears, or feels
A - Allergies
Sample #2
M - Medication
P - Pre-existing illnesses
L - Last food (food poisoning?
hypoglycemia?)
E - Events prior to the injury
The Secondary Assessment
Systematically look and feel (LAF)
Look for: DOTS
D - deformity
O - open wounds
T - tenderness
S - swelling
Start with the head for adults, feet for
children
Check The Head
DOTS
Feel both sides of the head
CSF fluid (clear fluid from ear or
nose / halo effect)
Check Eyes: PEARL
Are pupils equal and react to light?
Use flashlight or cover one eye with a
hand
Pupils normally contract in one second
No pupil reaction could mean death,
coma, cataracts, artificial eye
Check Eyes #2
Pupil dilation occurs within 30-
60 seconds of a cardiac arrest
Look for unequal pupils (stroke,
head or brain injury)
Check inner eye lid: it should be
pink
Check Neck and Chest
Check for cuts, bruises,
compare sides
Apply slight pressure to
sides of chest (checking for
broken ribs)
Abdomen
Ask if pain is present
If pain is present, gently press on
opposite side of pain site to help
determine area affected
Feel for lumps
Feel the 4 abdominal quadrants
Pelvis
Gently press downward
and squeeze inward
Extremity Assessment
Check arms and legs
deformity
tenderness
Check for :
C - Circulation (pulse sites)
S - Sensation
M - Movement
Extremity Assessment #2
Compare extremities
Check temperature of the
extremity
Check nail bed
instant refilling means good
circulation
normal refill time is < 2 seconds
Spine and Back
Ask victim about movement in
extremities
Wiggle fingers, toes
Have victim press foot against your
hand
Have victim squeeze your hand
Babinski reflex test
Injured? Big toe flexes upward
Check for a Medical
Alert Tag
24 hour emergency phone
number
Do not remove tag unless
absolutely necessary
Reassess ABCs:
Every 5 minutes if unconscious
or serious injury
Otherwise, every 15 minutes if
conscious
Role Play Secondary Survey
Lab Activity
Is There a Head or Spinal
Injury?
Always stabilize the head immediately
Signs of Spinal Cord Injuries
Painful movement of arms and legs
Numbness, tingling, weakness, burning,
lessened sensation in arms or legs
Loss of bowel or bladder control
Paralysis of arms or legs
Deformity
Always Remember!
RAPABCD

Post Emergency Numbers
Near The Telephone
Fire department
Police
Ambulance or EMS (paramedics)
Physician
Poison Control Center
Have You Ever Called 911?

Calling Emergency Medical
Services (EMS - 911)
A two minute delay in calling EMS
can be deadly
If in doubt, call EMS
Questions by dispatchers are not to
question the need of the call but to
determine the level of need
What To Tell 911
Dispatcher
First, speak slowly and clearly
When calling from a cell phone,
give the address immediately
Listen carefully to the
dispatcher
Tell The Dispatcher :
Location
Telephone number
What has happened
Number of persons needing help
Special conditions
Your assessment of the victim
Do not hang up unless the dispatcher
instructs you to