How to Examine a Conscious Casualty

After the initial assessment, or primary survey, is completed, you need to follow an examination routine to identify any injuries that the victim may have.

This examination can usually be carried out using a "no touch" technique, and can be completed simply by asking questions, observing and noting the answers given.

A systematic routine starts from the top of the body. You should continue with the entire survey even if they provide an answer that leads you to suspect something such as a limb fracture. Not completing a thorough examination or simply asking the victim to describe the painful area may prevent you from discovering something serious such as a spinal injury.

1. Start at the neck

Ask the casualty not to move his/her neck or head and ask the following:

• Does he/she have a sore neck?
• Does he/she have pins and needles in the hands or feet?
• Does he/she have weakness to any of the limbs?
• Does he/she have the ability to move all four limbs normally?

2. Move to the top of the head

• Don't let the casualty move his/her head
• Look over the head, face, nose for swelling, deformity, bleeding, fluid coming out of the ears
• Look for loose teeth or the inability to open the mouth or talk

3. Consider any injury to the chest

• Look for the rise and fall of the chest (both sides)
• Look for deformity of the ribcage or an increase in the rate of breathing
• Listen for noisy breathing (noisy breathing is obstructed breathing)
• Enquire about pain on movement or breathing

4. Ask about the stomach

• Enquire about pain to the abdomen

5. Look at the casualty's limbs

• Look for loss of movement, swelling, deformity or bruising
• Look for equal strength in both arms
• Look for equal strength in both legs
• Enquire about unusual sensations, e.g., numbness, coldness or tingling
• Does the pelvis hurt?

6. Look at the casualty's back

If you are completely sure that there is no injury to the spinal cord and there are no other injuries to the casualty that need your attention:

• With assistance, gently log-roll the casualty onto their side. Be careful - maintain casualty in straight position without twisting the neck or back
• Whilst still supporting the head and neck, look for deformity, swelling, bleeding or bruising

The Unconscious Breathing Casualty

When a person is showing signs of life and are breathing, but they cannot be woken from what looks like a sleep, they are said to be unconscious. When a casualty is unconscious, their muscles become relaxed, including the muscles that assist in swallowing. If they are not placed on their side they can choke or their stomach contents can enter their lungs. It is also possible that their tongue may fall back and block their airway. This can cause the casualty to lose his or her life. It is vitally important. The greatest danger to an unconscious breathing casualty exists whilst they are lying on their back. The first aider must ensure a clear and open airway by rolling the casualty gently on their side whilst protecting their neck and spine as much as possible.

Turn the casualty onto their side whilst manually supporting the head and neck. Once on their side you may also be able to obtain information about what happened from family or witnesses. Visible injuries and surroundings (e.g., a ladder and spilt paint may indicate the casualty has fallen from the ladder and struck their head) may also provide some clues.

If the casualty regains consciousness, you can then complete a thorough examination using the steps for conscious casualty assessment.

1. Provide safety

• Commence the basic first aid protocol, ensuring safety for both the casualty and rescuers. Call the ambulance immediately

2. Look for

• Unconsciousness is a state of unresponsiveness, where the casualty is unaware of their surroundings and no purposeful response can be obtained. If the victim is unconscious and not breathing, commence CPR

3. Causes

The causes of unconsciousness can be classified into groups. The following classifications (AEIOUTIPS) will help evaluate the reasons why the casualty is unconscious. The reason may be obvious.

• A Alcohol (e.g., too much)
• E Epilepsy (e.g., a seizure)
• I Insulin (e.g., too much or too little insulin in the body)
• O Overdoses (e.g., heroin/sleeping tablets)
• U Uraemia (renal failure is difficult to diagnose as a First Aider).
• T Trauma (e.g., car accidents, falls, hangings, severe blood loss)
• I Infections (e.g., to the brain)
• P Pretending (e.g., a person pretending to be unconscious to get medical attention to avoid a situation)
• S Stroke (a rupture or blockage to an area in the brain)

First Aid

Assess the casualty's response, e.g., "Open your eyes squeeze my hand" etc.

• An unconscious breathing casualty - should be turned onto their side (see pg 24)
• An unconscious casualty showing NO SIGNS OF LIFE - commence CPR

Turning the casualty onto their side:

• With as much assistance, as gently as possible, roll casualty onto their side
• The casualty should be in as near a true lateral position as possible with head dependent to allow free drainage of fluid
• When two first aiders are available, maintain head support at all times
• Special care should be taken to provide support and avoid any forward movement to the head, neck and spine in case of spinal injury
• Positioning an unconscious casualty on their side maintains a clear airway and facilitates free drainage of fluids
• It also reduces the risk of inhaling foreign material and allows good continuing observation of the casualty
• Good observation of and access to the airway should be possible