SIZING UP YOUR SCENE:
Practicing your first aid response requires imagination. Universally, first aid educators encourage learners to respond to an imaginary or simulated first aid scene, using the DRSABCD approach. This response model aids information retention – encouraging learners to perform each part of their response as a separate step. The most important step, of course, is D – for Danger!
I vividly recall my first ever first aid assessment scenario, as a high school student. I approached the ‘scene’ –a sparely furnished air-conditioned room with a manikin placed in the middle of the carpeted floor. I ‘performed’ (I mean that quite literally) my danger check with an exaggerated scan around the room. I then adopted a Steve Irwin-style stance, followed by a loud ‘crikey’, before approaching my plastic patient. I may perhaps have even ‘eliminated’ the dangers with a dramatic mime of shooing away a snake.
Entertaining, yes. Memorable? Obviously.
Did it prepare me for the dangerous scenes I would encounter ten years later as a trainee paramedic? Absolutely not!
In any real-life first aid situation, effectively sizing up your scene involves a comprehensive and, more importantly, conscious, act. Particularly in the wilderness, dangers are numerous, ever-evolving, and quite often, hidden. (Like a jumping jack ant in someone’s sleeping bag).
The DANGER hand
At WFAC, we care about our students. So much so, that you are Number 1 in our primary response model. Literally. (We even made a poem about it – more on that shortly.)
We encourage you to use your head, (and your hand) when approaching a first aid scene. The ‘DANGER HAND’ (as we’ve affectionately nicknamed it) helps you drop the play-acting, in favour of a more thought-out danger and scene assessment.
Here is the previously mentioned piece of poetry… (Read it out loud for best effect.)
Number 1: I’m #1!
Number 2: What happened to you?
Number 3: PPE.
Number 4: Are there any more?
Number 5: Will they survive?
Now… starting with your thumb, count each point off on one of your fingers, as you CONSCIOUSLY assess your imaginary ‘first aid scene’.
Here is each step in more detail:
1. I’m #1!
Look after number 1. My parents complain that I’m always looking after number one. In first aid, that’s a good thing! Without an intact ‘#1’ (you), the patient won’t get the help they need. Bystanders and the patient also need to be looked after (you can call them number 1.1 and 1.2). Do not enter a scene that is unsafe, and think about whether you and your bystanders are capable of dealing with what you see in front of you. It may be necessary to remove the patient from the dangerous scene if you can’t move the danger from the patient.
2. Assess the Mechanism of Injury (MOI).
Is it obvious what has happened to the patient? Was it a trauma (injury)? That is, did they fall from a tree, slip down a rock wall? Is it medical problem (illness)? Could it be environmental (temperature related, bites and stings, etc.)? Could it be all three? Assessing the MOI will make you think about dangers that are still present, such as unstable rocks or tree branches. It also helps you to anticipate potential injuries and illnesses.
3. Apply PPE, (Personal Protective Equipment)
This refers to gloves, eye protection or anything else you need to protect yourself. Think about blood, bodily fluid, or environmental factors. For example, should you don your climbing helmet if working around a cliff, or put on warm/waterproof clothes if treating on cold, wet or snowy ground?
4. Are there any more?
‘Beware the quiet patient’. Look around for more patients, or the patient or bystanders if there are any other people in difficulty. It may be wise to scout the area if possible. If casualties outnumber responders you will need to apply a triage system. In a pre-hospital context, the aim of triage is to determine the priority of treatment, so that responders can help as many people as possible. This is achieved by allocating resources to the casualties that will benefit most from treatment. This is slightly different to emergency department triaging systems, where casualties are ranked by the urgency or severity of their condition.
The first step in triage is to rapidly determine the number of patients, and the severity of their condition. This is done by conducting an initial primary survey on each patient, applying only immediate life saving interventions. Resources are the allocated based on triage ranking and treatment can commence.
5. Will they survive?
In some cases, the scene is so inaccessible, or the patient/s so injured, that commencement of first aid is unsafe, and/or futile. In this case, it is important to preserve the scene and contact emergency services ASAP. You may need to request Police and Fire services.
After you have assessed the scene as safe, or taken steps to make it so, you may proceed to the remainder of your Primary Assessment (RSABCD).
But remember that the bush is a dynamic environment. Be mindful of changing circumstances that may pose new safety risks, especially where you are dealing with an extended care first aid situation, such as overnight. Consider decline in weather, visibility, and condition of the patient.
And remember, you are Number 1!