Evaluate a Casualty

Conditions: You have a casualty who has signs and/or symptoms of an injury.

Standards: Evaluated the casualty following the correct sequence. All injuries and/or conditions were identified. The casualty was immobilized if a neck or back injury was suspected.

Performance Steps

Note. When evaluating and/or treating a casualty, seek medical aid as soon as possible. Do not stop treatment, but, if the situation allows, send another person to find medical aid.

WARNING

If there are signs of chemical or biological agent poisoning, immediately mask the casualty. If it is not nerve agent poisoning, decontaminate exposed skin and gross contamination (large wet or oily spots) of the clothing or overgarments. If nerve agent poisoning, administer the antidote before decontamination. (See Task 081-831-1044.)

WARNING

If a broken neck or back is suspected, do not move the casualty unless to save his life

1. Check for responsiveness.

   a. Ask in a loud, but calm voice, "Are you okay?"

   b. Gently shake or tap the casualty on the shoulder.

   c. Watch for a response.  If the casualty does not respond, go to step 2.

   d. If the casualty is conscious, ask where he feels different than usual or where it hurts.  Go to step 3.  If the casualty is conscious but is choking and cannot talk, stop the evaluation and begin treatment.  (See Task 081-831-1003.)

2. Check for breathing.

   a. Look for rise and fall of the casualty's chest.

   b. Listen for breathing by placing your ear about one inch above the casualty's mouth and nose.

   c. Feel for breathing by placing your hand or cheek about 1 inch above the casualty's mouth and nose.  If the casualty is not breathing, stop the evaluation and begin treatment.  (See Task 081-831-1042.)

Note. Check for pulse during mouth-to-mouth resuscitation, as necessary.

3. Check for bleeding.

WARNING

In a chemically contaminated area, do not expose the wound(s)

   a. Look for spurts of blood or blood-soaked clothes.

   b. Look for entry and exit wounds.

   c. If bleeding is present, stop the evaluation and begin treatment as appropriate.

       (1)  Arm or leg wound.  (See Task 081-831-1032.)

       (2)  Partial or complete amputation.  (See Task 081-831-1032.)

       (3)  Open head wound.  (See Task 081-831-1033.)

       (4)  Open abdominal wound.  (See Task 081-831-1025.)

       (5)  Open chest wound. (See Task 081-831-1026.)

4. Check for shock.

   a. Look for any of the following signs and/or symptoms.

       (1)  Sweaty but cool skin (clammy skin).

       (2)  Paleness of skin.

       (3)  Restlessness or nervousness.

       (4)  Thirst.

       (5)  Loss of blood (bleeding).

       (6)  Confusion.

       (7)  Faster than normal breathing rate.

       (8)  Blotchy or bluish skin, especially around the mouth.

       (9)  Nausea and/or vomiting.

   b. If signs or symptoms of shock are present, stop the evaluation and begin treatment.  (See Task 081-831-1005.)

WARNING

Leg fractures must be splinted before elevating the legs for shock. (See Task 081-831-1034.)

5. Check for fractures.

   a. Look for the following signs and symptoms of a back or neck injury:

       (1)  Pain or tenderness of the neck or back area.

       (2)  Cuts or bruises in the neck and back area.

       (3)  Inability of the casualty to move (paralysis or numbness).

           (a)   Ask about the ability to move (paralysis).

           (b)   Touch the casualty's arms and legs; ask whether he can feel your hand (numbness).

       (4)  Unusual body or limb position.

WARNING

Unless there is immediate life-threatening danger, do not move a casualty whom you suspect has a back or neck injury

   b. Immobilize any casualty suspected of having a neck or back injury by doing the following:

       (1)  Tell the casualty not to move.

       (2)  If a back injury is suspected, place padding under the natural arch of the casualty's back.

       (3)  If a neck injury is suspected, place a roll of cloth under the casualty's neck and put boots (filled with dirt, sand, etc.) or rocks on both sides of the head.

   c. Check the casualty's arms and legs for open or closed fractures.

       (1)  Check for open fractures.

           (a)   Look for bleeding.

           (b)   Look for bone sticking through the skin.

       (2)  Check for closed fractures.

           (a)   Look for swelling.

           (b)   Look for discoloration.

           (c)   Look for deformity.

           (d)   Look for unusual body position.

   d. If a fracture to an arm or leg is suspected, stop the evaluation and begin treatment.  (See Task 081-831-1034.)

6. Check for burns.

   a. Look carefully for reddened, blistered, or charred skin.  Also check for singed clothes.

   b. If burns are found, stop the evaluation and begin treatment.  (See Task 081-831-1007.)

7. Check for head injury.

   a. Look for the following signs and symptoms:

       (1)  Unequal pupils.

       (2)  Fluid from the ear(s), nose, mouth, or injury site.

       (3)  Slurred speech.

       (4)  Confusion.

       (5)  Sleepiness.

       (6)  Loss of memory or consciousness.

       (7)  Staggering in walking.

       (8)  Headache.

       (9)  Dizziness.

       (10)  Vomiting.

       (11)  Paralysis.

       (12)  Convulsions or twitches

   b. If a head injury is suspected, continue to watch for signs that would require mouth-to-mouth resuscitation (see Task 081-831-1042), treatment for shock (see Task 081-831-1005), or control of bleeding (see Task 081-831-1033).

8. Seek medical aid. Seek medical assistance as soon as possible, but do not interrupt treatment. If possible, send another person to find medical aid.