The immediate response to any sudden illness or injury requires a systematic approach to prevent further harm and maximize the chances of a positive outcome. Following a structured, sequential framework ensures that the most time-sensitive, life-threatening conditions are addressed first. This rapid, methodical assessment applies to any emergency situation and is designed to stabilize the individual until professional medical services arrive.
The Sequential Six Immediate Priorities
The initial assessment is formalized into six sequential priorities designed to guide the responder’s actions. The first step is to confirm the safety of the area before approaching. This involves scanning for hazards like unstable structures, traffic, fire, or exposed electrical wires, ensuring the responder does not become a victim. This step also includes using personal protective equipment (Body Substance Isolation or BSI) to prevent contact with bodily fluids.
Once the scene is safe, the next action is to assess the victim’s level of consciousness by gently tapping and shouting. If the person is unresponsive, look for clues to determine the mechanism of injury, which informs the potential for spinal injury. Simultaneously, the third priority is to activate the Emergency Medical Services (EMS) system by calling the local emergency number. This call should be made immediately for any unresponsive adult or severe injury.
With the scene safe and help notified, the fourth and fifth priorities focus on the individual’s ability to move air: Airway and Breathing. An open airway is paramount, as an unconscious person’s tongue can relax and block the throat, leading to oxygen deprivation. Once the airway is confirmed or opened, the responder must check for effective breathing by looking for movement of the chest or abdomen.
The sixth and final immediate priority is Circulation, which emphasizes the control of severe, life-threatening external hemorrhage. While checking for a pulse is part of a complete assessment, rapidly stopping massive blood loss takes precedence. Uncontrolled arterial or venous bleeding can lead to profound shock and death within minutes, making hemorrhage control an immediate life-saving intervention.
Advanced Assessment of Life Threats
Addressing the physiological threats to the airway, breathing, and circulation requires specific techniques. An unresponsive person often needs the airway opened using the head-tilt, chin-lift maneuver, unless a neck injury is suspected. This technique involves gently tilting the head backward while lifting the chin forward, which moves the tongue away from the back of the throat and relieves obstruction.
Assessing the adequacy of breathing involves looking for signs of distress. Responders should look for chest rise and fall, listen for breath sounds, and feel for air movement at the mouth and nose for no more than ten seconds. Inadequate breathing may be signaled by gasping, wheezing, or a bluish color change in the skin, indicating low oxygen levels. If normal breathing is absent, the responder must initiate rescue breathing or cardiopulmonary resuscitation (CPR).
Controlling severe external bleeding prevents the rapid onset of hypovolemic shock. The immediate action is to apply firm, direct pressure to the wound using a clean cloth or sterile dressing. If the bleeding is from a limb and cannot be stopped with direct pressure alone, a commercially available tourniquet should be applied high and tight above the injury. The current focus is on immediate, unrelenting pressure and the rapid application of a tourniquet for life-threatening hemorrhage.
Transitioning to Secondary Care
Once the six immediate life-saving priorities are addressed and the individual is stabilized, the focus shifts to secondary care while waiting for EMS. This phase begins with a detailed assessment to identify injuries or conditions that are not immediately life-threatening. The responder conducts a methodical physical examination from head to toe, looking for signs like swelling, deformity, or bruising.
Gathering a patient history is a major component of the secondary assessment, especially if the person is conscious. This is often done using the SAMPLE mnemonic, which guides the responder to ask about:
- Signs and Symptoms
- Allergies
- Medications
- Past medical history
- Last oral intake
- Events leading up to the incident
Collecting this detailed information provides professional responders with a complete picture of the individual’s health status.
Continuous re-assessment of the person’s breathing, responsiveness, and bleeding status is important during secondary care. The condition of an injured or ill person can change quickly, so the responder must monitor for any deterioration in vital signs. When the EMS team arrives, the responder should provide a structured handover report, using a communication framework like SBAR (Situation, Background, Assessment, Recommendation) to relay the sequence of events and all gathered information.