Author Topic: Advanced Casualty Assessment  (Read 25757 times)

adi

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Advanced Casualty Assessment
« on: March 28, 2013, 12:21:48 PM »
DRCABCDE

D – Danger, (SAFE TAC)

S – Shout / send / signal
A – Assess the Scene / Approach with caution
F – Find &/or free the casualties
E – Evaluate Requirement & send ETHANE report

T – Trace & Treat   
A – (ABC) Airway, Breathing & Circulation
C – Communicate findings


ETHANE Report

E – Exact Location
T – Type of incident
H – Hazards (Actual & Potential)
A – Access
N – Number of Casualties
E – Equipment Required

R – Response (AVPU)
   
A – Alert
V – Voice
P – Pain
U – Unresponsive   

C – Catastrophic Haemorrhage (CAT HEM)

Stop catastrophic bleeds

A – Airway (TWELVE FLAPS)

Trachea – Position or Deviation
Wounds – To neck
Emphysema – Escape of Air
Larynx – Position
Veins - (In neck) Venous Engorgement
Everytime

Feel – Place hands on chest thumb next to breast bone. Watch for equal left & right movement. Check collarbone and breast bone.
Look – Open wounds, bruising & abrasions 
Auscultate – Listen for chest sounds
Palpate – Check for obvious wounds and check blood on gloves.
Search – check armpits and back.

B – Breathing

Normal 12 to 20 bpm if 10 bpm & under or 30 bpm & over assist with breathing by giving 10 breaths a minute) 

C – Circulation

Check Pulse, Capillary refill, Blood Pressure, Stop Bleeding & replace Fluids)

D – Disability

Check AVPU, Pearl x 2 (Pupils Equal & Reactive to Light), Blood Glucose (4 & lower sugar/20 & higher Insulin, FAST (Face, Arms, Speech, Time)

E - Exposure & Environment

Provide shelter and insulation
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Callum

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Re: Advanced Casualty Assessment
« Reply #1 on: March 29, 2013, 09:40:31 AM »
Phew, that's a big mnemonic Adi for anyone to learn, maybe a wilderness medic who is working everyday but for the rest of us I doubt I would manage. Who is it targeted at?

adi

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Re: Advanced Casualty Assessment
« Reply #2 on: March 29, 2013, 11:38:28 AM »
Callum it is not one mnemonic it is many placed together in sequence of working with a casualty from start to hand off. It is how paramedics work but as first aiders we can leave out the bits we are not trained in.

It is from my notes I typed up from my medic course.
« Last Edit: March 29, 2013, 02:26:26 PM by adi »
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

adi

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Re: Advanced Casualty Assessment
« Reply #3 on: March 29, 2013, 11:42:53 AM »
DRCABCDE should be taught in every first aid course. I have broken down each letter further.

You may know it as DRABC, DRAB, DRSABC, Or as primary & secondary assessments. 
« Last Edit: March 29, 2013, 02:29:37 PM by adi »
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Lyle Brotherton

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Re: Advanced Casualty Assessment
« Reply #4 on: March 30, 2013, 08:59:32 AM »
Very comprehensive Adi (as always) For me I need to continually practice First Aid to stay proficient and I have printed your list onto a small plastic card as a memory aid. I use these even when with a casualty, and I know some of them are thinking 'Does this guy know what he is doing' ;)

Alan Mcgee who is a team member and paramedic developed a casualty assessment card which also acts as an aide mémoire, have you done this for your list?
“Opinion is the medium between knowledge and ignorance” - Plato

captain paranoia

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Re: Advanced Casualty Assessment
« Reply #5 on: March 30, 2013, 10:18:28 AM »
I've just revised my DofE aide memoire, a little A7 notelet printout of things I need to do whilst supervising DofE groups, including notes on emergency and first aid procedure.  These notes are very personal, and might not make a lot of sense to someone else, but I know what they mean.

I find checklists useful, but you have to be sure they're inclusive, and haven't missed something, especially if it's a kit list you're blindly following as you pack in a hurry...

As I've said before, I don't find the convoluted mnemonics to be very mnemonic for me, as I can never remember what they mean.  But my aide memoire/checklist serves the same purpose.

adi

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Re: Advanced Casualty Assessment
« Reply #6 on: March 30, 2013, 10:42:51 AM »
I don't Lyle although I should if I am going to asses a casualty to the standard described above. Ambulances carry aid memoirs on board. Because I get a lot of practice doing normal first aid assessments whilst I am teaching I remember how to do it.

As first aiders we don't necessarily have all the equipment we need to do all of the above nor the training. Some of the above is for very advanced first aid and only really needs to be considered if acting as a team medic on an expedition abroad and obviously you need to be trained. However if you expect to be with the casualty for any length of time because of the time it would take for evacuation to be arranged then it is worth trying to do as much of the above as possible as it helps you to build a picture of the situation and you may be able to work out what more you can do to promote recovery and of course the more information you can give to the emergency response the better prepared they will be when they get to you.

The more information you can get at the time of accident is helpful to monitor the casualties condition is worsening or improving. If capillary refill or blood pressure drops it may suggest the casualty is bleeding and if you have not found any bleed it would suggest they have internal bleeding.   
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Callum

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Re: Advanced Casualty Assessment
« Reply #7 on: March 30, 2013, 05:26:35 PM »
As obvious as it seems, I had not thought about carrying an aide memoir. So your list makes sense Adi as the ultimate checklist, which I guess you could use to what extent you choose, determined by the situation.

We currently use BASP to provide our courses and 3 year refreshers, yet for some time I have felt they are a little lightweight in content. Who do you provide for Adi?

adi

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Re: Advanced Casualty Assessment
« Reply #8 on: March 31, 2013, 02:40:10 AM »
Callum what course do you do? Is it an expedition & remote medicine course? My faculty is the Lifesigns group. I teach both first aid at work and expedition & remote medicine which are recognised by the outdoor NGO's and national outdoor governing bodies such as the MLTB, BCU, RYA ect. For the uk we teach venture medicine and there are more advanced courses for over seas expeditions.
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

adi

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Re: Advanced Casualty Assessment
« Reply #9 on: March 31, 2013, 03:03:26 AM »
I have just looked at the BASP site and see they do an outdoor emergency first aid course which sound similar to our venture course. What do they cover? If you are interested I will send you furthure information about the expedition & remote medicine courses we do tomorrow.
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Callum

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Re: Advanced Casualty Assessment
« Reply #10 on: April 02, 2013, 07:38:30 PM »
Hi Adi, busy weekend and ready for my two days off - next weekend  :o Will PM you tomorrow :)

captain paranoia

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Re: Advanced Casualty Assessment
« Reply #11 on: May 05, 2013, 11:51:56 PM »
I need to revise my aide memoire, and do some 'mental training'...

I've just completed a first aid course; yes, my first such course in 50 years.  And the content of the course was mostly familiar, and I thought I'd be fine when it came to the exercises.

Boy, was I wrong. The scenarios were pretty full-on (multiple casualties, 'tricks' etc.), but I was ashamed and dismayed at just how poorly I performed, even under this moderate stress. My brain shut down, and I got tunnel vision on my casualty ( the only good thing was that I did pick the most serious casualty, and diagnose and treat properly). But we failed to assess the scene properly, or call 999 until well into the exercise. But the worst thing was the total lack of communication between the rescuers, to the extent that when the second-most serious casualty was found in near-collapse by one rescuer, she tried to attract our attention by shouting to us at the top of her voice, but we simply didn't hear her, due to tunnel vision focus on our casualties.  The second exercise didn't go much better.

All in all, a very chastening experience.  Besides the obvious of doing more scenarios, does anyone have suggestions for mental training exercises to help stay calm, assess and, well, do a better job?

Lyle Brotherton

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Re: Advanced Casualty Assessment
« Reply #12 on: May 06, 2013, 08:48:46 AM »

An honest appraisal CP and something which we will all have encountered, to some level or other, in similar stress training exercises.

Captain paranoia said: does anyone have suggestions for mental training exercises to help stay calm, assess and, well, do a better job?

You are already doing it, in that simply recognising the problem and searching for an answer is the first major step forward.

‘Knock at the door and wait for the answer’

This phrase was given to me by a WEMT (Wilderness Emergency Medical Technician)

C&C (Command and Control) is central to your solution, normally a term associated with the military, yet it is also best practice for all first level responders (Police, Fire & Rescue and the Ambulance Service) and something which UK Mountain Rescue implements very well.

10 years ago I was at the Scottish Mountain Rescue Shell Conference held in Aberfeldy. These meetings were designed to share best practise amongst the Scottish MRTs through a series of lectures and also in practical exercises. There was a night exercise which involved a downed aircraft. Something which happens more frequently than is often known in the Scottish mountains, especially with military low-level training flights. In addition, we have had major air crash disasters, my own team, TVMRT, were in attendance at the Pan Am 103 Lockerbie incident and were some of the first responders’ on-scene.

UK Mountain Rescue teams create 'Hills Parties' for every incident, comprising of the members who turn up at the shout, meaning that the mix of responders is frequently different. Hill Parties are usually 5 responders and each person is assigned a specific role, these are:
1.   Hill party leader
2.   Navigator
3.   Safety officer
4.   First-aider
5.   Comms

Whilst thru MR training each member can fulfil each role, due to experience some people are better placed than others for specific tasks, for example a team member who in his work life is a paramedic will invariably be assigned First-aider - My role was regularly as the Navigator;)

OK, back to the night exercise at Aberfeldy and why this is so specific to your training requirements CP.

A group of around 25 volunteers were mustered on the hill and briefed as a group that there had been a reported aircraft crash in the near vicinity; we were given no other details.

The first thing that this team of people did, some of whom knew each other and others who did not, was agree the C&C. We chose an overall leader for the night (Incident Commander), a second in command (2IC) and a Runner; I will explain more about this last role later. This process took 10 minutes.

The IC & 2IC assessed the information report, then determined which areas were to be searched by each of the Hill Parties. When they had determined this the IC2 briefed the parties as a group. The first important feature is that the IC never has any direct contact with any of the Hill Parties. If he/she wishes to communicate with them or vice a versa they do so thru their 2IC or the Runner. This strategy allows the IC to have a clear head and complete situational analysis of the incident from the outset and it works excellently.

As the Hill Partys reported back their findings, from aircraft parts to casualty in a tree (a parachutist) the IC was able to coordinate the Hill Party activities and allocate resources accordingly. Similar to your training scenario, our incident contained wild cards, from un-exploded munitions near one of the casualties to an irate drunk farmer and his vicious dog.

People like structure, it is the premise of our society, and it is remarkable to observe people when they know exactly what their task is.

A few years later I was by chance the first on scene at a serious road traffic accident involving a cyclist who had been crushed by a wagon turning a corner.

I clearly remember standing still for a few moments, probably no more than one minute, assessing the situation, looking around for other casualties, where vehicles had stopped and if the area was safe (Knock at the door and wait for the answer’) and when I had established that I felt safe to enter the area of the incident I assumed control (Hill Party Leader) of the people surrounding the girl. I asked specific individuals if they could do certain tasks, could somebody call the emergency services and stay on the line to them (Comms), could some other people stop or divert the traffic past the incident (Safety Officer) were there any doctors or nurses who could help (First-aider). The system worked and the young girl, who had suffered horrendous injuries, lived.

You could write a book on this subject, and many people have, my advice would be if you feel confident assume control at such an incident and designate specific task to the individuals in attendance. You can build your confidence prior to ever having to do this by visualising how you will act, imagining what you will do at such an incident – effectively role playing it in your mind. It works for me.
“Opinion is the medium between knowledge and ignorance” - Plato

captain paranoia

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Re: Advanced Casualty Assessment
« Reply #13 on: May 06, 2013, 03:36:22 PM »
Yes, working as a structured team would certainly have helped, but this wasn't covered in the course, and I think we were all focussing on doing our first aid, rather than the wider emergency skills.

Waiting for a bit to allow the scene to sink in, and come up with a quick strategy would certainly help.  As I said at the outset, I need to do some mental rehearsal, so I might have a chance of being more capable in future.

Lyle Brotherton

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Re: Advanced Casualty Assessment
« Reply #14 on: May 06, 2013, 08:22:32 PM »
I was speaking to an educational specialist about your dilemma CP and explained to her the answer which I had provided. She observed that visualisation is one of the most important ways ion which we learn to both cope and deal with stressful situations, she recommends that you actualise verbalise, out loud, your imaginary scenario, ideally explaining your proposed actions to somebody else, if possible who has expert knowledge of the particular situation.
“Opinion is the medium between knowledge and ignorance” - Plato