by Nate Kennedy

The goal in an emergency situation is to establish control as soon as possible, and always provide the greatest good for the greatest number in the shortest time, while doing no harm. The Patient Assessment is designed to size up a scene and safely determine and treat life-threatening situations as quickly as possible.

• Look Around! Are there rocks falling overhead? Is there this ice below? Are dangerous gasses filling the tent?
• GLOVES ON! You don’t want to give or receive communicable disease

• If a rock climber fell, what did they land on? What position was he/she in? Were they wearing a helmet? Did a rope slow the fall?
• If a canoer is unconscious on shore, where is the canoe? Were there rapids? Were they alone? Wearing a helmet or life vest? Body suit (warmth)?
• It is possible for a substantial injury to be present that cannot be determined during initial assessment. Recognizing the MOI and the factors involved can make you aware of possible patient changes later on

• ALWAYS consider communicable disease as a risk, either for you or for the patient
• Keep disposable gloves available, and wear them at all times when dealing with a patient
• Wear glasses and a cover over nose and mouth when the scene involves spraying of contaminants (coughing, vomiting, spraying blood)
• Use a rescue mask with one-way valve if patient requires you breath for them

• Don’t forget to find and treat the quiet patients!

• Seriously Ill or Injured Person
  • Prepare for rapid assessment
  • Prepare for rapid treatment and decision for transport
    • Keep in mind rapid transport from wilderness situations is usually not possible
• Not seriously hurt or seriously ill
  • Prepare for a more relaxed assessment and treatment

• If there are no immediate threats to life, take the time to establish an open relationship and calm patient’s fear and anxiety
• Introduce yourself, and if needed, state your qualifications to provide care
• If possible, gain consent to treat. If unconscious, there is implied consent.
• If patient is unconscious, remember they still need to be treated with respect and compassion

The goal is to find and treat anything life-threatening. If you find something in this phase, you should immediately stop and treat it. As you approach the patient, quickly scan for immediate threats (blood squirting for an artery, for example). ABCDE provides a good guideline for treatment, but feel free to change the order if something life threatening is apparent.

• First step is to establish responsiveness to stimuli
• It is advisable to place one hand on the patient’s head as a reminder for them to remain still
• A good time to ask what happened – can you get more info on the MOI?
• If MOI indicates possibility of head or spine trauma, take control of head and neck and hold steady throughout assessment

• Airway
  • Is the patient breathing? Speaking? Then airway is open
  • Is patient unconscious, and airway sounds constricted, clear any blockage an use head tilt/chin lift or jaw thrust, if spinal damage is suspected
• Breathing
  • Ask conscious patient to take deep breath: is it painful, or constricted? If so, check chest for life-threatening injuries
  • If unconscious, with airway open, place ear above patient’s mouth and listen to quality of breathing while feeling the breath on your ear.
  • Simultaneously place other hand on chest or abdomen to feel for movement
  • Assess for 10 seconds. If patient is not breathing, you will have to begin breathing for them
• Circulation (and Bleeding)
  • With a conscious patient, check the Radial Pulse, located on the inside of the wrist on the thumb-side
  • With unconscious patient, check the carotid pulse on the neck of the side of the patient you are on (do not reach across the patient, as you can restrict airflow, and NEVER STEP OVER your patient!)
  • If you find no carotid pulse, you will have to start CPR
  • ***You are not stopping to count the pulse rate at this point, you are simply making sure it is there
• Disablity
  • Keep the patient as immobile as possible to prevent further damage to central nervous system (brain and spine) until it has been determined that there is no need to treat the spine
  • If the situation permits, ask the patient what the Mechanism of Injury (MOI) was to help determine possible disability.
• Exposure/Environment
  • Is clothing hiding an injury you should be treating?
  • Remove and/or cut away AS LITTLE AS POSSIBLE, as needed for treatment
  • Protect the patient’s modesty, and also remember the patient may need those clothes later on your expedition – the less damage the better
  • Always communicate with patient: What are you doing, and why?
  • Cold, heat, wind and rain are almost always factors in wilderness medicine. Acknowledge them early and do what it takes to care for your patient
  
  
  At this point, you will be making decisions about the patient’s future care. Does the mechanism of injury indicate serious underlying problems? Are the life-threatening situations at hand more than you are able to handle? If so, the patient should be transported as rapidly as possible. Unfortunately, rapid transport is not usually possible in the wilderness, and you should be making plans accordingly.
  
  DOCUMENT what you have discovered so far. See the section on SOAP NOTES (put in link to soap notes) for a reliable and well known method, otherwise just write down your findings, and be sure to send them with the patient!
  
  
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