In this series I am pleased to offer a ‘dirty’ First Aid approach. This is suited to kayakers and river users. Using a ‘find it fix it’ approach to incident care and management.
In our last article we looked at the Primary Assessment of a casualty. Now we move forward to a secondary assessment – here we deal direct with an injury or medical condition.
We will under take a full head to toe exam. Time to take a SAMPLE and deal with obvious injuries. Lets not rush at it – it needs to be spot on.
S – Signs and symptoms
A – Allergies
M – Medications
P – Previous medical issues
L – Last meal
E – Events
This sample is simple, we find it we fix it.
S. Here we find and deduce. A hands on detective. See, touch, hear. Bleeding, broken bones, swelling may not be as obvious as you think.
A. Any dog tags or medi bands, known allergic reactions.
M. What about medication, either prescription or over the counter – if so log it, like you did in your first survey.
P. Do we know any previous medical history? Old injury?
L. Can we identify when the last meal was?
E. Like Sherlock we need to piece together the events that brought about the incident.
During your head to toe exam, following the fact you know the ABC is without issues, adopt a calm manner and begin working down the body. ALWAYS TALK ABOUT WHAT YOU ARE DOING. Explain to any people watching and the causality as this will ease pressure and give witness should you need.
Signs and symptoms may well guide you toward their complaint and your initial treatment. Don’t forget this may not be the only issue. There could well be injuries that the casualty is not aware of. Is it appropriate to quick head to toe check?
Head, take off helmet – if spinal injury is suspected follow the Spine In Line Rules, covered in a later article. It may be sensible to use a group shelter to cover you, observers and the casualty – especially if you have to cut clothing.
Starting at the head feel around the scalps and the neck. Remember to look in ears, perhaps a small torch light (some phones have an app, you always carry your phone don’t you?) and check the pupils for dilation and movement. Covering one at a time. Then work slow and methodical down the body. Around the neck and wrist look for medi bands, these are clue givers. When checking arms and legs look and feel for differences and similarities.
Fingers and palms are often missed. On the torso check the ribs and chest – this is often difficult for the first aider in a river setting.
Don’t be afraid to feel up the inside of a PFD or dry top. Look in any pfd pocket for clues about medication that may need to be taken. You can also widen the search to dry bags in the boat belonging to the casualty.
When feeling over the dry wear you may mistake pooling of blood for pooling of water (leaking top). It’s best to get down and dirty on this one. Have a good feel around. In ideal situations gloves are a must, but do yo carry them? Can you even put them on over your cold wet hands? Some cannot, or don’t have. Remember that cold wet river hands touching somebody whose skin is warm under a dry suit will always give a reaction – nice (not).
How best to monitor what you have done is to always have a body map in your fist aid kit, so you can tick off, section you have looked at.
It acts as initial evidence to you and medical teams that arrive on site. Hell you can even revert back to ‘heads, shoulders, knees, toes’ a childhood song – that fits well to the task. A personal favourite of mine is to write location of any damage, if not obvious. I do like my marker pens…
Well that is another quick one for you to keep in the memory bank…. check back later and find why this pfd harness has been stripped?
Old man river Darren Clarkson-King (DAZ) will be supplying a series of ‘Dirty First Aid’ articles for river runners.
Darren offers in-house training in the Himalaya and is a consultant for Nepal Association of Rafting Agents (NARA) making a blue print for an Industry standard.
He also paddles a bit.