Initial assessment (for soccorista)

Initial assessment is an organized way to recognize and respond to life-threatening emergencies in a crisis. It can take from a few seconds to a minute, after which you either stay with the sick or injured person until further care arrives, or stay with them until both they and you agree it is o.k. for you to leave.

Take a deep breath
Imagine one of your friends is suddenly injured or sick. Or maybe you're the first one to find a person "down" at a protest. What do you do? Well, don't panic! Take a deep breath and think.

Survey the scene
Before approaching, Survey the scene:
 * Is it safe?
 * How many people need help?
 * What could be dangerous? Look for things like:
 * fire
 * falling debris
 * unstable structure
 * advancing police
 * an out-of-control crowd
 * traffic
 * How will you get close to them and how can you get to safety?

Eliminate or prepare for potential hazards to the injured or ill person, to yourself, and to bystanders. Try to make sure that whatever happened to your friend or comrade doesn't happen to you too!

Use any crowd for moving obstacles, directing traffic, getting help, and keeping a safe space around injured people. Try to speak in a calm voice to help keep others calm. Remember, most people want to help.

Introduce yourself

 * "Hi, I'm so-and-so. I know some first aid.

Determine if the person is alert

 * "Are you OK?"
 * "What's your name?"
 * "Do you know where you are? /what day it is? /what happened?"

If the person does not respond to normal conversation, shout and tap-- but do not shake them, since this could make a neck or spine injury worse.

Get their consent
Find out if they are willing to accept your care. If they don't want to talk to you or be touched by you, or whatever, do your best to find out why and get them help that they will accept.

What you discover during the first part of initial assessment affects how you do the second part. When you surveyed the scene and determined if the person was alert, you probably got an idea of the mechanism of injury or illness (MOI), which is a fancy word for the cause of the problem. Do you think the person fell? Were they in a fight? Are they drunk? Pay attention.

The most important thing to ask before going on is:

Check the ABCs
This is a way to review the potential life-threats to a person before moving on to focus on one particular problem. Always assess and treat systems in their order of priority. A comes before B....
 * Airway
 * Breathing
 * Circulation
 * Disability
 * Environment

A-- is the Airway open?
If the person talked to you normally, the airway is open. If they didn't talk, put your face next to theirs and look, listen, and feel for breathing for 15 seconds:
 * Look to see if their chest rises
 * Listen for sounds of breathing
 * Can you feel breath on your cheek?

B-- is the person Breathing?
If they can talk normally to you, they are breathing, right?If they didn't talk, and there seems to be no airway obstruction, but no breath is coming out or in, the problem might be with their breathing system.

C-- is their Circulation compromised?
The circulatory system is contained within the heart and blood vessels. If the person is breathing, their heart is beating. Don't waste time taking their pulse unless you know how.
 * Look for bleeding. Remember that bulky clothing, sand, or rocks might disguise blood loss. Blood loss may also be internal. Even if you find one bleeding injury, keep looking-- there may be other hidden injuries that are more severe.
 * If they are pale, cool, and clammy, and if they are becoming less alert, consider that they may be entering shock.

D-- have they been Disabled?
Any person who cannot think, move, or take care of themselves as they normally do-- or any person with a potential spinal injury-- is disabled.
 * Stay with them until they recover or help arrives.

E-- have they suffered / will they suffer Exposure to a dangerous environment?
While the environment in which you provide first aid might feel fine to you, pay attention to its effect on the sick or injured person. Think of other environments which can seriously hurt an injured or sick person. Remember that the purpose of initial assessment is to discover threats to a person's life, and protect against those first, before providing general first aid.
 * Extremes of heat and cold can complicate any first aid, but cold exposure is more dangerous than heat. Any person with serious blood-loss, burns, or any injury that leaves them disabled needs to be kept warm and dry in all but the hottest of weather.

Document your care
It is a good idea to keep notes about any problems you encounter in your initial assessment. Some medics put strips of duct tape on their pants and keep basic notes on it with permanent marker. They number their patients to maintain patient confidentiality, and take notes like this:
 * # 1
 * 19yo F w/(L) leg wound
 * "shot w/tear gas cannister"
 * A-- ok
 * B-- ok
 * C-- ok (minor bleeding (L) lower leg)
 * HR elevated w/i normal range
 * D-- difficulty moving w/o assistance
 * Pain 4 (out of 5) with pressure
 * E-- cold
 * Plan-- help her move inside warm bar, elevate leg, first aid, get to health center.

Many medics write their notes after they have completed initial assessment and basic first aid, so that they can give the person all their attention. Documentation is always important, and becomes more important the more assessment skills you know, and the longer the person will be in your care.

Re-assess as needed
Signs for some life-threats take a while to show up. Keep an eye on the person while they are in your care. If they can talk, have a conversation. Not only is it good for their morale, but you can quickly assess changes in their level of alertness.

If the person's condition appears to change, assess again. Also, if you are going to be with the person a long time, assess them every few minutes, 15 minutes, hour, or few hours, depending on how injured or ill they are. Write down any changes for the better or worse.