The ability to manage an emergency situation begins not with action, but with a rapid, systematic assessment of the environment and the individual in distress. This initial evaluation is the foundation for all subsequent care, guiding the responder to prioritize immediate, life-saving interventions over less pressing concerns.
Prioritizing Personal and Environmental Safety
The absolute first step in any emergency is ensuring the safety of the scene, a principle often summarized as “If it’s not safe, don’t go.” Before approaching a victim, a responder must quickly scan the area 360 degrees to identify any potential environmental hazards. These hazards can include obvious dangers like moving traffic, downed electrical wires, fire, or unstable structures, as well as less apparent threats like hazardous materials or aggressive individuals. If a danger is present, the immediate priority shifts to mitigating that threat or moving the victim to a safe location, but only if it is feasible and safe to do so.
Protecting oneself from infectious disease is an equally critical component of scene safety, referred to as Body Substance Isolation (BSI). BSI is based on the assumption that all body fluids, such as blood, saliva, and urine, are potentially infectious. The immediate use of personal protective equipment (PPE), most commonly disposable gloves, is necessary to minimize the risk of pathogen transmission between the victim and the responder. This precaution ensures the rescuer does not become a secondary victim.
Rapidly Assessing the Victim’s Status
Once the scene is deemed safe, the focus shifts immediately to the victim’s immediate, life-threatening conditions, a process known as the primary survey. The first check is for responsiveness, which is accomplished by tapping the person and shouting loudly, “Are you okay?”. The level of consciousness is quickly categorized using the AVPU scale: Alert, Verbal, Pain, or Unresponsive.
Following the check for responsiveness, the responder must rapidly assess the victim’s airway, breathing, and circulation, which are the fundamental elements of life support. Current protocols emphasize checking for normal breathing by looking for chest rise and fall, and listening for air movement. In adults, if the person is unresponsive and not breathing normally, the focus shifts immediately to initiating chest compressions, as this addresses the most time-sensitive life threats: lack of circulation and severe bleeding.
A rapid scan for severe, life-threatening external bleeding is performed next, as massive hemorrhage can lead to death within minutes. Any blood loss that appears profuse or spurting requires immediate direct pressure to the wound. Controlling this type of bleeding is integrated into the primary survey because it can be managed simultaneously with checks of consciousness and breathing. The entire primary assessment must be completed in a matter of seconds to quickly identify and manage any conditions that pose an immediate threat to life.
Initiating the Emergency Response System
After establishing scene safety and performing the primary survey, the next crucial step is initiating the emergency response system, typically by calling 911 or the local emergency number. This step is often delegated to a bystander if one is available, allowing the primary responder to remain focused on providing direct care to the victim.
The caller must clearly state the exact location of the emergency, providing specific details like the street address, cross streets, or nearby landmarks. Next, a brief and accurate description of the nature of the emergency and the victim’s condition is necessary, such as “motor vehicle accident with an unresponsive person” or “person with severe bleeding”. Provide a callback number and remain calm while answering any additional questions the dispatcher asks, as they are gathering details to guide the responding units.
Beyond the First Steps: The Secondary Examination
Once immediate life threats are managed and professional help is on the way, the responder can proceed to the secondary examination, a more detailed assessment. This stage is conducted only on victims who are either responsive or have had their life-threatening conditions stabilized. The secondary survey involves a systematic head-to-toe check for injuries that were not immediately apparent during the rapid primary assessment.
A key component of this examination is gathering a medical history, often using the SAMPLE mnemonic. This helps to collect information on:
Signs and symptoms
Allergies
Medications
Past medical history
Last oral intake
Events leading up to the incident
This detailed information is then passed on to emergency medical services upon their arrival, providing them with a comprehensive picture that aids in definitive treatment.