Patient Assessment, a tricky skill for first aiders
Patient Assessment in First Aid
I think it is fair to say that patient assessment is the weakest link for most first aiders. This is not surprising as time is of the essence in first aid courses these days, and this area is only just touched on within the course curriculum.
To be exact, this is the section within Provide first aid HLTAID003 that deals with patient assessment.
• how to conduct a visual and verbal assessment of the casualty
Let's look at this a little more closely.
The Industry skills council state in their first aid implementation guide that the following should be assessed:
Visual assessment: careful observation of casualty and note what you see
Verbal assessment: Ask questions and note the answers
Within our first aid courses we use mnemonics to help first aiders remember a basic patient assessment format, but I have seen that even using these mnemonics students have huge difficulty in remembering this part of the content.
In my ambulance world, patient assessment and history taking really is a key to my treatment of a patient. I think that students of our first aid courses have difficulty with this because it is a skill that takes time to develop. Knowing what sort of questions to ask a patient with a medical condition can be a little trial and error even with ambulance guidelines, as any student ambulance paramedic can attest. First aiders thrown into an emergency incident can struggle.
We have mnemonics for all sorts of things, SAMPLE, PQRST, SEEP, DRSABCD, PILSDUCT, RICER...the list goes on.
How is a layperson supposed to remember all these when they may have one first aid incident in 12 months, if they are unlucky? Other people are dealing with first aid on a daily basis and are using some sort of patient assessment tool regularly. So as i said, it is not surprising that the layperson struggles with these concepts.
The problem is that there is no "out of the box" assessment for every patient that you may come across. The first aid assessment is really specific to the particular injury or illness. For example you are not going to go through questions regarding the PQRST of pain if the patient is having an asthma attack.
In most of first aid, there is a specific treatment for a specific problem. For example, if someone is bleeding, you are to examine the wound, place pressure on the wound, elevate the wound and bandage appropriately. This means that the first aider must be able to do a basic diagnosis of the issue at hand. This is obviously very difficult again for the layperson and I don't believe that diagnosis really comes under the basic first aid banner. Don't get me wrong, the basic first aider must consider a cause of illness, in anaphylaxis for example before administration or an adrenaline auto injector but by and large diagnosis takes some thorough history taking and patient assessment.
With this in mind, here are some questions for the layperson to ask after going through the DRSABCD action plan
• What is their name?
• What has happened?
• Do you have any pain? - Go through PQRST of pain
• Secondary Assessment if necessary - Treat Life threatening bleeding
• Treatment of obvious injury or illness
• Assess SAMPLE - Signs and symptoms, Allergies, Medications, Past History, Last Meal and Events leading up to the incident (What were they doing when the incident happened)
All of this information can be relayed to ambulance paramedics when they arrive.
Patient assessment is not an easy skill to learn. Mnemonics help but they also come with their own set of challenges and I'm not sure if they are widely remembered and used. If all else fails it is important to use the DRSABCD action plan and perhaps remember the SAMPLE mnemonic too.
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