in future front-line environments. If this becomes the
case, longer ground chains of evacuation to the
battalion aid station or division clearing station may be
required. This will increase the need for life-stabilizing
activities before each step in the chain and in transit.
Evacuation triage will normally be used for personnel
in the Class II and Class III treatment categories, based
on the tactical situation and the nature of the injuries.
Class IV casualties may have to receive treatment at
the BAS level, and Class I personnel will be treated on
the line.
Remember, triage is based on the concept of saving
the maximum number of personnel possible. In some
cases, a casualty may have the potential to survive, but
to ensure that casualty's survival, the treatment
necessary may require a great deal of time and
supplies. As difficult as it may be, you may have to
forsake this patient to preserve the time and supplies
necessary to save others who have a greater potential
for survival.
PATIENT ASSESSMENT IN THE FIELD
LEARNING OBJECTIVE:
Recognize the
assessment sequence for emergency medical
care in the field, and identify initial equipment
and supply needs.
Patient assessment is the process of gathering
information needed to help determine what is wrong
with the patient. Assessments that you conduct in the
field (at the emergency scene) or during transport are
known as a field assessments.
Field assessments are normally performed in a
systematic manner. The formal processes are known
as the primary survey and the secondary survey. The
primary survey is a rapid initial assessment to detect
and treat life-threatening conditions that require
immediate care, followed by a status decision about the
patient’s stability and priority for immediate transport
to a medical facility. The secondary survey is a
complete and detailed assessment consisting of a
subjective interview and an objective examination,
including vital signs and head-to-toe survey. (Both
types of surveys will be discussed in more detail later
in this chapter.)
BEFORE ARRIVAL AT THE SCENE
Before or during transit to an emergency scene,
you may learn about the patient’s illness or injury.
Although this information could later prove to be
erroneous, you should use this time to consider what
equipment you may need and what special procedures
you should use immediately upon arrival.
ARRIVAL AT THE SCENE
When you arrive at an emergency scene, you need
to start gathering information immediately. First,
make sure the scene is safe for yourself, then for the
patient or patients. Do not let information you received
before your arrival form your complete conclusion
concerning the patient's condition. Consider all related
factors before you decide what is wrong with the
patient and what course of emergency care you will
take.
You can quickly gain valuable information as to
what may be wrong with the patient. Observe and
listen as you proceed to your patient. Do not delay the
detection of life-threatening problems. Be alert to
clues that are obvious or provided to you by others.
Some immediate sources of information may come
from the following:
The scene
¾Is it safe or hazardous? Does the
patient have to be moved? Is the weather severe?
The patient
¾Is the patient conscious, trying to
tell you something, or pointing to a part of his
body?
Bystanders
¾Are they trying to tell you
something? Listen. They may have witnessed
what happened to the patient or have pertinent
medical history of the patient (for example, prior
heart attacks).
Medical identification device
¾Is the patient
wearing a medical identification device (necklace
or bracelet)? Medical identification devices can
provide you with crucial information on medical
disorders, such as diabetes.
Mechanism of injury
¾Was there a fire? Did
the patient fall or has something fallen on the
patient? Is the windshield of vehicle cracked or
the steering wheel bent?
Deformities or injuries
¾Is the patient lying in
a strange position? Are there burns, crushed
limbs, or other obvious wounds?
Signs
¾What do you see, hear, or smell? Is there
blood around the patient?
Has the patient
vomited? Is the patient having convulsions?
Are the patient’s clothes torn?
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