Examination of an accident scene

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Equipment for the practical skill

• protective medical gloves;
• full body human mannequin (patient care simulator).

Clinical situation:

• You see a person lying on the room floor with his eyes closed without signs of bleeding

The procedure for performing a practical skill

• Check the scene
  • a)  Check for hazards (Is the scene safe to enter?): traffic, fire and smoke, unstable position of a vehicle or part of a building, downed electrical wires, pouring flammable or chemically, violence possibility, infection and etc.
  • b)  Take note of anything that might tell you the cause of the emergency (What happened? What is your initial impression about the nature of the person’s illness or injury?): sudden illness, loss of consciousness for no apparent reason, convulsions, road accident, fall on slippery walkways and roads, falling objects, overheating or hypothermia, fire, use of weapons and etc.
  • c)   Determine the number of victims (How many people are involved?): one or more and pay attention to persons: who is moving or making noise, who has very visible injuries, who is silent and not moving, who obscured by debris or wreckage.
  • d) Take note of persons who can be of assistance (Is anyone else available to help?): bystanders, participants in the incident who do not receive damage.
• Check of the person to reveal other life-threatening conditions: unresponsiveness, trouble breathing, severe bleeding.
  • Check the person's consciousness (check the victim for a response):
    • shout to get the person’s attention, using the person’s name if you know it or ask loudly "Are you all right?".

• • • If there is no response, tap or gently shake the person’s shoulder (if the person is an adult or child) or the bottom of the person’s foot (if the person is an infant) and repeat "Are you all right?"

• • • try to find out what is wrong with him and get help if needed; reassure him regularly
•  Call to bystanders for help. Send someone to (if necessary): bring an AED and a first aid kit, eliminate a possible threat, control traffic, restrict a crowd, shine a lantern, move a casualty, call to EMS and etc.
• Turn the person onto his or her back.
• Open the airway:
  • place your hand on his forehead and gently tilt his head back;
  • with your fingertips under the point of the victim's chin, lift the chin to open airway.

• Check breathing:
  • look for chest movement;
  • listen at the victim's mouth for breath sounds;
  • feel for air on your cheek;
  • look, listen and feel for no more than 10 s to determine if the victim is breathing normally.

• Check the carotid pulse:
  • locate the carotid artery medial to the sternomastoid muscle (between the muscle and the trachea at the level of the cricoid cartilage, which is in the middle third of the neck);
  • with the pads of your three fingers, gently palpate the carotid artery, one at a time;

• • avoid palpating the upper third of the neck, because this is where the carotid sinus area is located. you want to avoid pressure on the carotid sinus area because this can lead to vagal stimulation, which can slow the heart rate, particularly in older adults.
• It may be difficult to be certain that there is no pulse. This rapid assessment should take no more than 10 s.
• Alert emergency medical services. If possible, ask someone else to make the call 103 so that you can begin giving care. The person making the call should be prepared to give the dispatcher the following information:
  • the location of the emergency (the address, or nearby intersections or landmarks if the address is not known);
  • the nature of the emergency (e.g., whether police, fire or medical assistance is needed);
  • the telephone number of the phone being used;
  • a description of what happened;
  • the number of injured or ill people;
  • what is help, if any, has been given so far, and by whom.
• If you are alone and there is no one to send to call the designated emergency number, you may need to decide whether to call first or give care first. Most of the time, you will call first and then give care.
  • Call first for:
    • any person about 12 years or older who is unresponsive;
    • a child or an infant whom you witnessed suddenly collapse;
    • an unresponsive child or infant known to have heart problems;
    • a cardiac arrest. In cardiac arrest, the priority is getting help on the scene as soon as possible because early access to EMS personnel and an AED increases the person's chances for survival.
  • o   Care first (give immediate care, then call 103 or the designated emergency number) for:
    • an unresponsive infant or child younger than about 12 years whom you did not see collapse;
    • a person who is choking;
    • a person who is experiencing a severe allergic reaction (anaphylaxis) and has an epinephrine auto injector;
    • a person who has severe, life-threatening bleeding;
    • if the patient has no signs of life (consciousness, purposeful movement, normal breathing, or coughing), or if there is doubt, start CPR immediately until more experienced help arrives or the person shows signs of life.
• Give care according to the conditions that you find.
• If the person is responsive and awake, start secondary examination (see Practical skill “Secondary examination of a person at an accident scene”)
• If the patient is unresponsive and has signs of life or is responsive but not awake:
  • interview bystanders;
  • check the person from head to toe;
  • provide care for any conditions found;
  • roll the person onto his or her side into the recovery position;
• If the patient is unresponsive and has no signs of life:
  • start CPR;
  • do not interrupt resuscitation until:
  • a health professional tells you to stop;
  • the person is definitely waking up, moving, opening eyes and breathing normally;
  • you become exhausted.