# Assessment

## Scene Assessment

Scene assessment is the critical first step in any emergency response situation. It involves quickly evaluating the environment and circumstances surrounding an emergency before approaching or treating any victims. This systematic evaluation ensures the safety of both the first aid provider and the victim while determining the best course of action.

Why Scene Assessment is Important

1. Safety First

Protects rescuers from becoming additional victims
Prevents further harm to existing victims
Ensures a safe working environment for providing care

2. Situational Awareness

Helps understand what caused the emergency
Identifies potential ongoing threats
Determines the scope and severity of the situation

3. Resource Planning

Assesses the number of victims needing help
Determines what type of help is needed
Identifies available resources and bystanders

Remember
Never rush into a scene without proper assessment. A few seconds of evaluation can prevent you from becoming part of the problem rather than the solution.

How to do a Scene Assessment ?

Mentally Prepare

Stop: Pause for 1–2 seconds before moving in.
Observe: Use all your senses — look, listen, smell — before you approach.
Think: Base on what you have sensed, try thinking in methodically way to analyze the possibilities.
Plan: Decide your approach, where you’ll stand, and how you’ll exit.

Remember
Keep your breathing slow and steady, approach with care. A calm rescuer makes better, safer decisions.

Identifing Hazards and Potential Dangers

Look for specific dangers and decide how you’ll control or avoid them:

Traffic and moving machinery: oncoming cars, bikes, forklifts, etc.
Fire/heat/smoke/explosion risk: flames, burning smell, popping sounds, gas cans. Keep distance; don’t enter smoke-filled or fire areas.
Electrical: downed wires, damaged outlets, water near power.
Gas/chemicals/odors: fuel, solvents, chlorine/ammonia smells, hissing from cylinders. Otherwise back out and call EMS/fire.
Water and environment: deep/fast water, ice, flooding, extreme heat/cold, lightning.
Structural instability: collapsed roofs/walls, falling debris, unstable vehicles, ladders, broken glass.
Violence/security: weapons, aggressive persons, fights.
Animals/insects: any animals that may harm you or victim; wasps, snakes, bear, wolf, etc.

Call for help

If you not sure what to do, what you can do or the environment will put you in danger, you should always call EMS or other bystanders for help.

Is it safe to enter?

Ask yourself:

Can I reach the victim without putting myself at significant risk?
Can I keep a clear exit path the whole time?
Do I have the PPE and help I need?

If any answer is “no,” keep your distance, secure the area, and call EMS. Your safety comes first.

Survey the scene for the mechanism of injury

Use what you see to predict injuries and priorities:

Trauma clues: vehicle damage, broken glass, skid marks, height of a fall, sharp/blunt objects, helmet damage, furniture/wall impact, blood patterns.
Medical clues: medication bottles/inhalers/insulin, glucose meters, medical alert bracelets, oxygen equipment, recent illness, environmental stress (heat/cold).

Mechanism of injury informs you the injuries is a result from external factors or medical illness or disorder.

Spinal injury clues

A fall from height
Head, neck or back injury that caused by a external force.
Clear injury at head, neck or back.

Continually monitor for change

Scenes change. Stay alert at all tiem and reassess every period or after any new event:

Worsening fire/smoke, raising water level, shifting traffic, changing weather/light.
Crowd or aggressor behavior changes.
New odors, sounds (hissing, cracking), or structural movement.
Patient condition changes.

If the risk increases, move yourself to safety first, then direct the patient/bystanders if possible. Always maintain an exit route.

## Victim Assessment

Primary Assessment - ABC Approach

A – Airway: Is the victim's airway open and clear?
B – Breathing: Is the victim breathing normally?
C – Circulation: Check for signs of circulation, such as movement or normal skin color.
LOC – Level of Consciousness: Is the person awake or not responding?

Step 1 - Level of Consciousness

Approach, identify yourself, and get consent if possible.
Tap and shout: "Are you okay?", squeeze or pinch gently if applicable.
If unresponsive: call EMS. Put cellphone on speaker if you’re alone.

AVPU Assessment for Level of Consciousness
Alert: Open eyes and follow instructions
Voice: Does not open eyes and only responds to voice
Pain: Only react to painful touch
Unresponsive: No respond to verbal or painful touch

Step 2 - Airway

Open the airway with a head-tilt, chin-lift.
If you suspect head/neck/spine injury, use a jaw-thrust technique.
Remove objects that blocking the airway if possible and safe.
Turn victim to their side if find difficult in removing it with fingers.

Step 3 - Breathing

Look, listen, and feel for breathing for 5 seconds.
Keep victim's airway open.
Watch the chest and abdomen for rise and fall; listen and feel for air at the mouth and nose.

Step 4 - Circulation

If victim is breathing, check for major bleeding.
If victim is NOT breathing, start CPR immediately.

Why there is no pulse check ?
The pulse check was removed from the primary assessment for lay rescuers in the American Heart Association (AHA) and European Resuscitation Council (ERC) guidelines due to its inaccuracy and the significant time delay it caused in starting CPR.
First aid provider can assume cardiac arrest for a unconscious non-breathing victim.

Decision Flowchart

Multiple Victim Situation

In a multiple-victim incident, do a very quick primary survey on each person to identify who has treatable life-threatening problems. In situations with severely limited or not enough resource, prioritize and treat the victims with severe, life-threatening injuries who have a high probability of survival.

The main priority categories in resource-limited situations are often color-coded (Developed by Hoag Hospital and Newport Beach Fire Department):

Red (Immediate): Victims with severe, life-threatening injuries who have a high probability of survival with immediate intervention and transport (e.g., airway obstruction, massive bleeding). These are treated first to save the maximum number of lives.
Yellow (Delayed): Victims with serious but not immediately life-threatening injuries whose transport can be delayed for a few hours without significant risk of deterioration (e.g., stable fractures, some burns).
Green (Minor/Walking Wounded): Victims with minor injuries who are stable and can often assist in their own care or wait for treatment until the more critical patients are managed.
Black (Expectant/Deceased): Victims who are unlikely to survive given the severity of their injuries and the limited available resources. Palliative care and pain relief are provided, but life-saving resources are allocated to those with a higher chance of survival.