Performing an injury assessment

Focus on first aid

Neck or back pain

If the patient complains of head, neck or back pain, immediately stop the assessment. Continue to stabilize the head and neck and wait for EMS to arrive.

Thanks to Ernesto, this past week we all had an opportunity to practice our hurricane plan and make necessary preparations for a storm.

It was abundantly obvious that, as a whole, we are much more diligent with our preparations than we were pre-Ivan and for this we can give ourselves a well deserved pat on the back.

It is also very refreshing to see that many residents of Cayman are including first-aid/CPR training in their preparations.

We all know that in the aftermath of a major storm roads may be blocked to some parts of the island and EMS personnel may not be able to respond to an emergency as quickly as they normally would.

In the event that we find ourselves caring for an ill or injured person and EMS is delayed or unavailable, it is important to know how to assess the patient’s condition and possibly transport them to medical help ourselves.

As we have learned, we begin treating all patients by performing a ‘primary assessment’ and following the ABCD’S of the ‘lifeline’.

Once we have determined that the patient is breathing and has circulation, and we have treated serious bleeding and shock, we can perform a secondary assessment.

This assessment may include checking for a possible illness, checking for less obvious injuries, or both, and it provides us with valuable information on the patient’s condition.

Injury assessment

As always, don your barriers (gloves) and explain to the patient that you are going to check them for injuries. Explain what you are doing throughout the assessment and ask the patient to inform you of any pain.

Stabilize the patient’s head and neck and instruct them to answer your questions verbally. Do not allow the patient to move or nod their head.

Immediately stop the assessment if the patient complains of head, neck or back pain. Continue to stabilize the head and neck and wait for EMS to arrive. (Note: special techniques for transporting a patient with head, neck or back injuries are covered in most first-aid courses).

Start your assessment at the head and work your way down the body to the toes.

Feel for deformities on the patient’s face by gently running your fingers over the forehead, cheeks and chin.

Check the ears and nose for blood or fluid. If present, suspect head injury and stop the assessment.

Place a finger in front of the patient’s eyes. Without moving the head, have the patient follow your finger with their eyes. Check for smooth tracking and determine that the eyes are moving together. Also, check pupil size. If you have a flashlight you can check to see that the pupils are reactive to light.

Feel the skull and neck for abnormalities. If the patient complains of pain, stop the assessment.

If you can reach the shoulder blades, slide or place one hand over each shoulder blade and gently push inwards.

Move your hands outward to the shoulders and gently press inward with the palms.

Run two fingers over the collarbones from the shoulders to the center.

Place one hand on the shoulder to stabilize the arm and gently slide the other hand down the upper arm, elbow and wrist. Ask the patient to wiggle their fingers. Repeat on the other arm.

Inspect the chest for deformity. Place your hands, palm in, on each side of the chest and gently push inward.

Gently feel along the patient’s spine for abnormalities. Cover as much area as possible without moving the patient.

Gently push on the patient’s abdomen on both sides, above and below the navel.

Place your hands on the hip bones, palm in, and gently push inward.

Starting at the thigh, slide your hand down the upper leg, knee and ankle as you did with the arm. Ask the patient to wiggle their toes and press the sole of the foot against your palm. Repeat on the other leg.

Note areas of pain or abnormality and report to EMS when they arrive or when the patient has been transported to medical care.

Continue to monitor the ABCD’S of the patient’s lifeline.

This weekly column is only an introduction to emergency care skills and is designed to increase interest in First-Aid/CPR training. For information on courses please contact the Red Cross, a medical professional, or a local dive shop.

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